Published: 2016-12-24

A comparative study on post-operative pain relief by intrathecal buprenorphine hydrocholoride with control group

Rashmi Dubey, Roseline Zohra Ali, Nishant Baghel, Khalid Beg


Background: Surgical trauma is a real and severe tissue damage resulting in surgical pain which is a universal phenomenon. Post-surgical pain experienced by patient is often significantly greater than anticipated by the patient. Recognition that inadequate analgesics adversely affect the patient’s cardiovascular, pulmonary and emotional status has spurred development of new and highly effective methods of controlling pain. The benefits of postoperative analgesia are speedy recovery, reduction in physical and mental stress, improvement in pulmonary function (by allowing the patient to cough, breath and move more easily), less stress on cardiac function, decreased incidence of thromboembolic complications. Buprenorphine is a highly lipid soluble narcotic of antagonist agonist type which is 40-50 times more potent than morphine. As per available previous researches, low dose of intrathecal buprenorphine produces prolonged postoperative analgesia with lesser side effects.

Methods: The present study was carried out in the department of anaesthesiology, CCM medical college, Durg, Chhattisgarh, India during study period August 2015 to July 2016. The study comprised of 80 patients undergoing surgery of lower abdomen below umbilicus (T10) and lower limbs. Patients of age Group between 20-60 years of age of either sex of ASA group I and II were included in the study. Pre-anesthetic evaluation was done prior to surgery. The patients were randomly divided into 2 groups [group-I (control), group II (Buprenorphine hydrochloride 0.06 mg intrathecally)] of 40 patients each. All the patients were informed about visual analogue scale preoperatively. After the surgical process, observations were recorded. The assessment of results of both groups were done. The results were analysed by unpaired’ test and p value.

Results: Mean age in both the groups were comparable and statistically insignificant (p>0.05). Mean age in group I was 39.3±1.5 years and group II was 38.5±12.2. In group II, there was male predominance i.e. M: F was 3: 2, whereas in group I sex ratio was equal (M: F was1:1). Mean weight in both groups were comparable and statistically insignificant (p>0.05). In group I mean weight was 49.5±2.5 kg and 45% pts. Were between 40-50 kg weights. In Group II mean weight was 50.9±8.2 kg and 40% patients were between 40-50 kg weights. Patients receiving study drug has significantly rapid onset of sensory block as compared to control Group (p<0.05). Patients of group II had significantly rapid onset of motor block (p<0.05). The mean duration of surgery in group I was 90.8±44.0, and group II 115.0±40.0 min. The mean duration of motor block in Group I was 190.5±57.2 min and group II was 186.5±30.1 min (3.12+ 0.52 hours). Duration of absolute and effective analgesia is significantly higher in Group II. VAS score is significantly lower in group II patients. There was no statistically significant change in systolic blood pressure, diastolic blood pressure and pulse rate attributable to intrathecal buprenorphine.

Conclusions: On the basis of observation and results of our study we conclude that buprenorphine has been found to be superior for postoperative analgesia as compared to control group.


Buprenorphine, Post operation, Pain

Full Text:



Abram SE, Winne RP. Intrathecal acetyl cholinesterase inhibitors produce analgesia that is synergistic with morphine and clonidine in rate. Anesth Analg. 1995;81:501-7.

Angelo Robert D, Dean LS, Meister GC, Nelson KE. Neostigmine combined with bupivacaine, clonidine, and sufentanil for spinal lobor analgesia. Anesth Analg. 2001;93:1560-4.

Borg PA, Krijnen HJ. Long-term intrathecal administration of midazolam and clonidine. The Clin J Pain. 1996;12:63-8.

Bouaziz H, Tong C, Eisenach JC. Postoperative analgesia from intrathecal neostigmine in sheep. Anesth Analg. 1995;80:1140-4.

Sakuntal C. Buprenorphine in epidural analgesia for postoperative pain. Ind J Anaesth. 1984;32(2):243.

Cox RF, Collins MA. The effects of benzodiazepine on human opioid receptor binding and function. Anesth Analg. 2001;93:354-8.

Crawford ME, Jensen FM, Toftdahl DB, Madsen JB. Direct spinal effect of intrathecal and extradural midazolam on visceral noxious stimulation in rabbits. Br J Anaesth. 1993;70:642-6.

Peter DO, Nitescu PV, Appelgren LK, Curelaru ID. Intrathecal infusion of bupivacaine with or without buprenorphine relieved intractable pain in three patients with vertebral compression fractures caused by osteoporosis. Anasth Pain Med. 1999;24:352-7.

Eisenach JC, Hood DD, Curry R. Phase I human safety assessment of intrathecal neostigmine containing methyl- and propylparabens. Anesth Analg. 1997;85:842-6.

Thomas W. Intrathecal buprenorphine for postoperative analgesia. Ind J Anaesth. 1997;41:188-9.

Tan PH, Liu K, Peng CH, Yang LC, Lin CR, Lu CY. The effects of dexamethasone on postoperative pain and emesis after intrathecal neostigmine. Anesth Analg. 2001;92:228-32.

Tan PH, Chia YY, Lo Y, Liu K, Yang LC, Lee TH. Intrathecal bupivacaine with morphine or neostigmine for postoperative analgesia after total knee replacement surgery. Can J Anaesth. 2001;48(6):551-6.

Liu SS, Hodgson PS, Moore JM, Trautman WJ, Burkhead DL. Dose- response effects of spinal neostigmine added to bupivacaine spinal anaesthesia in volunteers. Anaesthesiology. 1999;90:710-7.

Batra YK, Jain K, Chari P, Dhillon MS, Shaheen B, Reddy GM. Addition of intrathecal midazolam to bupivacaine produces better postoperative analgesia without prolonging recovery. Inj J Clin Pharmacol Ther. 1999;37(10):519-23.

Lalla RK. Low dose intrathecal buprenorphine for postoperative analgesia. Ind J Anaesth. 1997;41:38-42.

Chansoriya KP. Intrathecal buprenorphine for postoperative pain relief. Ind J Anaesth. 1987;35(5):332.

Jagtap S. Intrathecal Narcotics for post-operative pain relief. Ind J Anaesth. 1991;39:191-3.

Kim MH, Lee YM. Intrathecal midazolam increases the analgesic effects of spinal blockade with bupivacaine in patients undergoing haemorrhoidectomy. Br J Anaesth. 2001;86:77-9.

Lauretti GR, Vera MS. Intravenous ketamine or fentanyl prologs postoperative analgesia after intrathecal neostigmine. Anesth Analg. 1996;83:766-70.

Chung CJ, Kim JS, Park HS, Chin YJ. The efficacy of intrathecal neostigmine, intrathecal morphine, and their combination for post-cesarean section analgesia. Anesth Analg. 1998;87:341-6.

Singh AP, Kaur R, Gupta R, Kumari A. Intrathecal buprenorphine versus fentanyl as adjuvant to 0.75% ropivacaine in lower limb surgeries. J Anaesthesiol Clin Pharmacol. 2016;32:229-33.

Ipe S, Korula S, Varma S, George GM, Abraham SP, Koshy LR. A comparative study of intrathecal and epidural buprenorphine using combined spinal-epidural technique for caesarean section. Indian J Anaesth. 2010;54(3):205-9.

Rabiee SM, Alijanpour E, Ali J, Rostami S. Benefits of using intrathecal buprenorphine. Caspian J Intern Med. 2014;5(3):143-7.