Comparative Evaluation of Tramadol and Butorphanol as an Adjuvant to Bupivacaine for Supraclavicular Block: A Randomised Clinical Study

Abstract

Introduction: Brachial plexus blocks have become useful alternatives to general anaesthesia for forearm surgeries. When used as a sole agent, Local Anaesthetics (LA) do not provide adequate pain relief. Tramadol and Butorphanol are synthetic opioid analogues that, when added to Bupivacaine, improve the quality of the block and reduce the need for supplementary postoperative opioids. Aim: To evaluate the effect of Tramadol and Butorphanol as adjuvants to Bupivacaine for supraclavicular brachial plexus block on sensory and motor block characteristics. Materials and Methods: This double-blinded randomised clinical study was conducted in the Department of Anaesthesiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from January 2021 to June 2022. The patients were randomly allocated into two groups of 30 each: group T received 0.5% Bupivacaine 25 mL with 50 mg Tramadol, and group B received 0.5% Bupivacaine 25 mL with 1 mg Butorphanol. The primary objective was to study the onset and duration of sensory and motor blockade. The secondary objectives were to study the duration of postoperative analgesia, requirements of rescue analgesia, and drug-related adverse effects in supraclavicular brachial plexus block. Fisher’s exact test and the Chi-square tests were used to compare categorical variables. Results: Group T and group B was 38.30±13.75 years and 38.30±14.79 years, respectively. Demographic data were comparable in both groups. A faster onset of sensory block and motor block was seen with Tramadol than with Butorphanol (p-value <0.001). The duration of sensory and motor block was longer with Butorphanol than with Tramadol (p-value <0.001 and p-value=0.01, respectively). The time to first rescue analgesia was longer with Butorphanol (p-value <0.001). Beyond six hours, the Visual Analog Scale (VAS) score was significantly lower in group B, except at the 12th hour. Very few incidents of adverse events were recorded in both groups. Conclusion: The authors concluded that adding Butorphanol in a dose of 1 mg to Bupivacaine showed a delayed onset for sensory and motor block but prolonged duration of sensory and motor block, as well as the duration of postoperative analgesia, compared to the addition of 50 mg Tramadol, without producing any significant adverse effects.