A COMPARATIVE STUDY OF PROPOFOL WITH BUTORPHANOL AND PROPOFOL WITH NALBUPHINE FOR TOTAL INTRAVENOUS ANAESTHESIA IN SHORT SURGICAL PROCEDURES

Abstract

A comparative study was conducted to evaluate the efficacy of Butorphanol (20 μg/kg) and Nalbuphine (0.1 mg/kg) as adjuvants to propofol in total intravenous anaesthesia (TIVA) for short surgical procedures. Sixty patients undergoing elective surgeries were randomly assigned to receive either Butorphanol or Nalbuphine in a single-blinded study. Haemodynamic parameters, including heart rate and blood pressure, were monitored, and pain scores were assessed intra-operatively and post-operatively. While both groups maintained stable blood pressure, the heart rate was significantly lower in the Butorphanol group. Intra-operative bradycardia (heart rate < 60 beats/min) was more common in the Butorphanol group. Recovery times were comparable between the two groups, with no reports of awareness. Quality of analgesia, as measured by pain scores, was similar in both groups, though Nalbuphine provided longer postoperative analgesia. The study concluded that both Butorphanol and Nalbuphine are effective as adjuvants in TIVA, with Nalbuphine offering a slight advantage in postoperative pain management.

Materials and Methods

A prospective, randomized, and single-blind study was conducted involving 60 patients aged 16–60 years, randomly assigned into two equal groups receiving either 20 mcg/kg Butorphanol IV (Group B) or 0.1 mg/kg Nalbuphine IV (Group N) 10 minutes before induction of general anesthesia. Patients were monitored for changes in blood pressure, heart rate (HR), perioperatively and duration of analgesia, and the Anesthetized Patient Pain Scale (APPS) postoperatively. The results were recorded and analyzed statistically using Pearson’s Chi-square test for Independence of Attributes/Fisher’s Exact Test and Student’s t-test for continuous variables.

Results

A statistically significant fall in heart rate (HR) and mean arterial pressure (MAP) was observed in both groups during the intraoperative period, with a more pronounced decrease in the Butorphanol group. The duration of analgesia was statistically longer in Group N (Propofol with Nalbuphine) compared to Group B (Propofol with Butorphanol) (240 ± 35 minutes vs. 200 ± 30 minutes, P=0.001). Post-operative sedation, assessed using the Post-Anaesthetic Discharge Scoring System (PADS), was higher in Group N, as the time to achieve a PADS score suitable for discharge was less in the Butorphanol group. The incidence of post-operative nausea and vomiting (PONV) was similar in both groups, with no statistically significant difference.

Conclusion

Both Butorphanol and Nalbuphine as adjuvants to propofol in total intravenous anesthesia (TIVA) showed satisfactory results in maintaining hemodynamic stability and providing a long duration of analgesia for short surgical procedures. When compared, Nalbuphine provided a longer duration of analgesia, while Butorphanol was associated with less post-operative sedation. Thus, Nalbuphine may be preferred for extended analgesia, whereas Butorphanol may be more suitable when quicker recovery and discharge are desired.