2023, Vol. 6, Issue 1, Part B

Aims: To compare the efficacy of opioids viz. butorphanol, fentanyl and nalbuphine as a part of TIVA using propofol as an inducing agent in all the three groups in laparoscopic cholecystectomy in view of Haemodynamics variables, analgesia and recovery characteristics.

Material and Methods: This randomised prospective study was conducted in ninety patients of ASA grade I of either sex, in the age group of 20- 60 yrs and weighing 30- 70 kg undergoing laparoscopic cholecystectomy. Patients in group I received 25 μg/kg of inj. butorphanol intravenously, group II received 2 μg/kg of inj. fentanyl intravenously and group III received 0.3 mg/kg of inj. nalbuphine intravenously just before induction of anaesthesia. Induction was carried out exclusively with IV agents with inj. propofol 2 mg/kg and inj. vecuronium bromide 100μg/kg intravenously. Anaesthesia was maintained with TIVA using propofol infusion according to the Bristol infusion regimen and intermittent top-up doses of muscle relaxant. Haemodynamic monitoring, recovery characteristics in form of emergence time and recovery time, duration of analgesia, sedation and any side effects were recorded.

Results: In our study, it was found that butorphanol maintained a better steady state of haemodynamics throughout the intraoperative period as compared to fentanyl and nalbuphine. The attenuation of pressor response was again better with butorphanol, although fentanyl also suppressed this response to some extent. In view of recovery parameters, butorphanol and nalbuphine showed slow recovery in comparison to fentanyl whereas butorphanol provided better analgesia than the other two drugs.

Conclusion: To conclude, the study demonstrated the agonist-antagonist type of opioids can be a suitable alternative to the scheduled agonist opioids like fentanyl.