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Indian Journal of Clinical Anaesthesia


Comparison of epidural morphine and epidural buprenorphine - combined with general anaesthesia for laparoscopy assisted vaginal hysterectomies: A randomized double blinded study


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Author Details: Krishna Prabu R, Radhakrishnan A

Volume : 3

Issue : 2

Online ISSN : 2394-4994

Print ISSN : 2394-4781

Article First Page : 170

Article End Page : 178


Abstract

Introduction: Epidural opioid when combined with general anaesthesia (GA) for laparoscopy assisted vaginal hysterectomies (LAVH) effectively attenuates stress response caused by carbon dioxide (CO2) pneumoperitoneum. Moreover epidural opioids provide effective pain relief in the post-operative period.
Objectives: To compare intra-operative hemodynamics and post-operative pain relief between epidural morphine and epidural buprenorphine when combined with GA for LAVH.
Methods: 40 patients posted for LAVH under American Society of Anaesthesiologists (ASA) physical classification I and II were randomly allocated into two groups. Group M received 3mg morphine and Group B received 0.15mg buprenorphine with 14ml of 0.25% bupivacaine in epidural route before GA. Blood pressure and heart rate were recorded in all the patients before epidural injection, after induction of GA, after pneumoperitoneum along with trendelenburg position, every 10minutes after pneumoperitoneum and after desufflation and straightening the table. Duration of post-operative analgesia was recorded and injection tramadol in 50mg increments was used as rescue analgesia. Total tramadol consumption was also recorded in all the patients.
Results: There was a statistically significant decrease in heart rate and blood pressure over time in both the groups (p<0.05). When compared between the groups there was no statistical significance (p>0.05). The duration of analgesia was significantly longer in Group M compared to Group B (p<0.05). Total tramadol consumption in Group M was significantly lesser than Group B (p<0.05).
Conclusion: Epidural morphine and epidural buprenorphine are equally effective in attenuating stress response in LAVH when combined with GA. Epidural morphine provides better post-operative analgesia compared to epidural buprenorphine.

Keywords:
Buprenorphine; Epidural; Hysterectomy; Laparoscopy; Morphine