~ 106 ~ International Journal of Medical Anesthesiology 2020; 3(1): 106-113 E-ISSN: 2664-3774 P-ISSN: 2664-3766 www.anesthesiologypaper.com IJMA 2020; 3(1): 106-113 Received: 26-11-2019 Accepted: 29-12-2019 Pankaj Kumar Senior Resident, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India Sudha Singh Senior Resident, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India Aditya Prakash Assistant Professor, NMCH, Jamuhar Sasaram, Bihar, India Akhileshwar Assistant Professor, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India Corresponding Author: Sudha Singh Senior Resident, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India Comparative study of outcome in epidural bupivacaine with buprenorphine and bupivacaine with fentanyl in lower limb surgeries Pankaj Kumar, Sudha Singh, Aditya Prakash and Akhileshwar DOI: https://doi.org/10.33545/26643766.2020.v3.i1b.77 Abstract Pain is a complex subjective experience which has been proved difficult to measure in reproducible way. It is found that operative pain is more severe after surgery and thereafter gradually diminishes over next 24 hours. Providing effective analgesia for patients undergoing major surgery is a daily challenge for most anesthetists. The treatment of acute postoperative pain is a major health care issue. Epidural anesthesia /analgesia is one of the best accepted techniques for lower limb surgeries as it provides good sensory and motor block, decreases adverse physiologic responses to surgery such as autonomic hyperactivity, cardiovascular stress, tissue breakdown, increased metabolic rate, pulmonary dysfunction, and immune system dysfunction. Intraoperatively, sensory and motor blockade, quality and duration of Postoperative analgesia, hemodynamic and respiratory parameters, side effects like nausea, vomiting, respiratory depression, urinary retention. In this observational study an effort was made to study the peri operative analgesic efficacy of Inj. buprenorphine and Inj. fentanyl with 0.5 % Bupivacaine epidurally for lower limb surgeries. There were no significant hemodynamic and respiratory side effects in either of the groups. The postoperative analgesia was definitely of a longer duration with the Buprenorphine group. So it is concluded that epidural Buprenorphine is better in providing prolonged satisfactory postoperative analgesia as compared to Inj. Fentanyl. Regarding the side effects, the incidence of nausea and vomiting was more in buprenorphine as compared to fentanyl group, which could be easily treated with antiemetic’s like Ondansetron. Both buprenorphine and fentanyl along with bupivacaine 0.5% can be given epidurally as a single shot injection for perioperative analgesia obviating the need for epidural catheter. Keywords: Analgesia, bupivacaine, fentanyl, buprenorphine Introduction The word pain is derived from the Greek term poine (“penalty”) [1] . Pain is not just a sensory modality but is an experience. The international Association for the study of pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”. The father of the field of pain management as we know today is John. Bonica. He founded the international association for study of pain in 1974. Other than psychological trauma, pain is shown to affect the physiology of almost all the system including respiratory, cardiovascular and metabolic, thereby increasing the morbidity [2] . Regional anesthesia has lots of advantages as compared to GA for lower limb surgeries. The advantages are [3] 1. Awake patient 2. Poly pharmacy avoided 3. No airway manipulation 4. Good motor and sensory blockade 5. Early food intake by the patient 6. Less incidence of post-operative nausea and vomiting 7. Prolonged postoperative analgesia 8. Ideal operating conditions can be met 9. Reduce incidence of hypercoagulability 10. Decreases the incidence of myocardial infraction and postoperative pulmonary complication.