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Introduction: Butorphanol is a synthetic opiod agonist on (kappa) receptor and antagonist or partial agonist on µ (mu) receptor. Epidural Butorphanol has been used successfully for post operative pain relief. It is safer than pure agonist opioids because of its ceiling effect on respiratory depression, lower addiction potential, lesser nausea, vomiting, pruritus and also produces sedation. Nalbuphine is antagonist of and receptor agonist. Aims and Objectives: To compare the effects of Butorphanol and Nalbuphine with Bupivacaine given in epidural route as adjunct to spinal anesthesia in infraumbilical gynecological surgeries for post operative analgesia. Materials and Methods: This study was done in Department of Anesthesiology of M.K.C.G Medical College from June 2021 to August 2022, Berhampur, Odisha; India. Total of 80 female patients of age 15-50 years of ASA grading I & II were scheduled for elective gynecological surgeries under combined spinal and epidural anesthesia(CSE). On the day of surgery the selected cases were randomly placed into two groups of 40 each; Group-B: received 10 ml of 0.125% Bupivacaine+1ml(1mg) of butorphanol and Group-N: received 10 ml of 0.125% Bupivacaine+1ml(10mg) of Nalbuphine. Operation was allowed after achievement of block height up to T8. After 2 segment regression of block height i.e T8 to T10, total amount of drug studied were injected to group-B and group-N respectively. Vital parameters such as heart rate, BP, respiratory rate and SpO2 were monitored every 5 minutes for next 30 min, every 30 min for next 2hrs and 2hrly for next 12hrs postoperatively. Onset time, duration and quality of analgesia was recorded using visual analogue score (VAS) and compared in two groups. Results: No significant difference in mean heart rate(MHR) from 0 minutes to 360 minutes between both the groups B and N. MHR in group-B was 83.65/min and group-N was 80.40/min at 480 minutes(p =0.02) which is statistically significant. Mean Arterial Pressure (MAP) of both the groups are comparable from 0 to 240mins and are not statistically significant but p-value of MAP in 360 and 480 mins was < 0.05 and this change is blood pressure might be due to onset of pain between 120 to 240mins in group-N and 360 to 480 mins in group B. The mean onset of analgesia was 6.20 minutes and 6.50 minutes in group-B and group-N respectively. The mean duration of analgesia was 398.45 minutes in Group B and 222.88 minutes in Group N. The duration was significantly longer in butorphanol group. Among all, 37 cases (92.5%) and 38 cases(95%) have good pain score on evaluation after 30minutes of administration of epidural drug which is statistically significant followed by 3 cases(7.25%) and 2 cases(5%) have fair pain score from group-N and group-B respectively. Sedation as side effects found in 85% and 50% of cases butorphanol and nalbuphine group respectively. Current study shows that 10% of cases in group-B and 5% cases in group-N had nausea and vomiting, which is major side effect of nalbuphine group. No patients in nalbuphine group and butorphanol group had pruritus in this study. Conclusion: Opioid analgesics with local anesthetics are extremely safe, effective and reliable method of post-operative pain relief. Epidural Butraphanol in a dose of 1mg with 0.125% bupivacaine, provides longer duration of analgesia with better pain score and more sedation which is advantageous for post operative patient as compared to 10 mg of Nalbuphine with 0.125% bupivaine. [ABSTRACT FROM AUTHOR]

Introduction: Middle Ear Surgeries (MESs) are generally performed using local anaesthesia under sedation. Butorphanol and nalbuphine both are well-known synthetic opioid with agonist-antagonist characteristics. However, no reports present a direct comparison of the analgesic efficacy of these two drugs. Aim: To evaluate analgesic efficacy of intravenous butorphanol versus intravenous nalbuphine during Monitored Anaesthesia Care (MAC) in patients undergoing tympanoplasty. Materials and Methods: This randomised clinical trial was conducted at the Department of Anaesthesiology, School of Medicine, D.Y. Patil Deemed to be University, Mumbai, Maharashtra India, from March 2018 to March 2021. Total 112 adult patients, undergoing tympanoplasty, were randomly allocated into two groups. Group N received 0.2 mg/kg nalbuphine intravenous (i.v.) and group B received i.v. 0.02 mg/kg butorphanol. The patients were then evaluated for analgesic efficacy, sedation, blood pressure, Mean Arterial Pressure (MAP), Heart Rate (HR), Respiratory Rate (RR), blood oxygen levels (SpO2), Visual Analogue Scale (VAS) Score, need for intraoperative rescue sedation/analgesia, duration of action and side-effects. Results: A significant difference was observed in the patients' responses to needle prick, where only 8 (13.3%) subjects gave a vocal response in group N versus 22 (36.6%) in group B. A significant difference in the mean time of onset of pain amongst both the group was recorded (3.16±1.38 hrs in group N and 2.63±1.19 hrs in group B). A significant difference was also recorded in the mean VAS at 15th (p-value=0.012) and 30th min (p-value= 0.017). Only 7 patients (11.6%) from group N, and 12 patients (20%) from group B required rescue agent (0.5 mcg/kg/ hour dexmedetomidine injection and 75 mg diclofenac sodium injection intravenous). Conclusion: Both 0.2 mg/kg nalbuphine and 0.2 mg/kg Butorphanol provide satisfactory results in terms of analgesic efficacy, sedation, hemodynamic and respiratory parameters, albeit, nalbuphine can be coined to be superior in terms of response to pin prick and duration of action. [ABSTRACT FROM AUTHOR]

Background and Aims: Conscious sedation plays a significant role in in-office pharmacological behavior management for short-term procedures in children and apprehensive adults. The advantage conscious sedation provides is by improving quality of care provided by decreasing pain and anxiety while maintaining a patent airway and adequate spontaneous ventilation. Methodology: Present review was conducted to evaluate recent trends regarding use of in-office pharmacological sedation agents in India. A rigorous search was conducted through five electronic databases namely PubMed, Scopus, Web of Science, Cochrane Database, and CTRI (Clinical Trial Registry – India). The search period was defined to be last 5 years, that is, from 1st January 2014 to 31st July 2019. Terminologies "Conscious Sedation," "In-office Sedation," "Midazolam," "Nitrous Oxide," "India" were included in the search. The Boolean Operation "OR" and "AND" were applied to combine the terminologies. Results: A total of 20 studies were identified following strict inclusion and exclusion criteria. The included studies were evaluated for study design, speciality involved, number of individuals and their age groups, drugs compared along with route and dosage, procedures undertaken, place of study and results. Dental fraternity (13) had more number of trials conducted as compared to medical fraternity (7) in the stimulated period, with South Indian region having maximum trials registered or published. Conclusion: Midazolam was observed to the drug of choice for in-office sedation procedures in Indian Scenario. The limitation of study is that the published clinical studies are limited to a few states of India. [ABSTRACT FROM AUTHOR]

Background and Aims: Nalbuphine as well as butorphanol as adjuvant to intrathecal bupivacaine have been studied in comparison to bupivacaine alone. Both are kappa receptor agonist and have never been compared for its efficacy in terms of postoperative analgesia. The aim of this study was to evaluate duration of postoperative analgesia as well as intraoperative block characteristics using intrathecal nalbuphine hydrochloride (800 μg) or butorphanol (25 μg) as adjuvant to hyperbaric bupivacaine (12.5 mg) in lower limb fracture femur surgeries as compared to active control, that is, saline and bupivacaine. Material and Methods: This prospective, randomized, double-blind, active control study was conducted on 90 adult patients of either sex belonging to ASA grade I/II, aged 18–70 years, being operated for fracture femur surgeries in tertiary care hospital of North India. Patients were randomly divided into 3 groups (n = 30) Group A: received 0.5% hyperbaric bupivacaine 12.5 mg with 800 μg nalbuphine. Group B: Received 0.5% hyperbaric bupivacaine 12.5 mg with 25 μg butorphanol. Group C: Received 0.5% hyperbaric bupivacaine 12.5 mg with normal saline. Total volume injected was 3.0 ml. Duration of analgesia, mean VAS scores, requirement of rescue analgesia in 24 h along with intraoperative sensory or motor characteristics of block and hemodynamic parameters were studied. Statistical analysis was done using ANOVA with post-hoc Tukey test, Student's t-test and Chi-Square test. Results: Demographic profile was comparable among all the three groups. Mean duration of postoperative analgesia was 348.33 ± 66.96, 156.17 ± 43.9 and 110.36 ± 29.18 min in group A, B, and C, respectively (P = 0.006). Total doses of rescue analgesia were least in group A (32), followed by group B (42) and group C (64), respectively (P = 0.001). Group A had significantly earlier onset of sensory action (P = 0.03) as compared to group B and C. There was significant difference in sensory (P = 0.08) and motor duration (P = 0.04) among all the three groups. However, onset of motor block, haemodynamic profile and side effects were comparable among groups A, B, and C (P > 0.05). Conclusion: Addition of 800 μg nalbuphine and 25 μg butorphanol as adjuvant to intrathecal bupivacaine has better outcome as compared to active placebo group. But intrathecal nalbuphine was more effective compared to intrathecal butorphanol in terms of prolonging postoperative analgesia, reducing rescue analgesic doses and onset of sensory block. However, hemodynamic profile and side effects were comparable among all groups. [ABSTRACT FROM AUTHOR]