Comparative Study of Effectiveness of Tramadol and Butorphanol as Adjuvants to Levobupivacaine for Supraclavicular Brachial Plexus Block

BACKGROUND: Butorphanol and tramadol, the synthetic opioid analgesics, have been used alone or in combination with a local anesthetic in supraclavicular brachial plexus block. AIM: The aim of this study was to evaluate the sensory and motor block characteristics with the addition of tramadol (100 mg) and butorphanol (2 mg) to levobupivacaine for supraclavicular brachial plexus anesthesia. SETTINGS AND DESIGN: This study was a prospective, randomized, double–blind, and comparative study. MATERIALS AND METHODS: Patients were randomly allocated to three groups of 30 each. Group A received 0.5% levobupivacaine (25 mL) and saline in 5 mL, Group B received 0.5% levobupivacaine in 30 mL with 100 mg tramadol, and Group C received 0.5% levobupivacaine in 30 mL with 2 mg butorphanol. The duration of sensory block was evaluated as a primary outcome and other parameters as secondary outcomes. STATISTICAL TESTS: Statistical analyses were performed using Chi-square test for nonparametric data and analysis of variance for parametric data. RESULTS: Onset time of sensory block was fast and comparable in both Group B and C as compared to Group A (P = 0.000). Group C had the longest duration of sensory block and duration of analgesia followed by Group B and Group A. Group C and Group B showed statistically longer duration of motor block as compared to Group A (P = 0.000). Hemodynamic derangements and adverse effects were comparable. CONCLUSION: Butorphanol (2 mg) as an adjuvant to levobupivacaine in supraclavicular block hastens the onset and prolongs the duration of the block as well as postoperative analgesia to a greater extent as compared to the addition of 100 mg tramadol.