A prospective randomized double-blinded study comparing intrathecal nalbuphine vs intrathecal fentanyl added to 0.5% hyperbaric bupivacaine for perioperative anaesthesia and postoperative analgesia in patients undergoing hernioplasty
Journal Title: Medpulse International Journal of Anesthesiology - Year 2019, Vol 9, Issue 3
Abstract
Background- Various adjuvants are added to the local anesthetics intrathecally, to prolongate the duration of anesthesia. Among the adjuvants the most commonly preferred are the opioids. Opioids like fentanyl, morphine, buprenorphine and nalbuphine have been administered intrathecally to fasten the onset time and increase the duration of sensorimotor blockade. In this study we compared the merits of intrathecal adjuvants fentanyl / nalbuphine when added to 0.5% hyperbaric bupivacaine in patients undergoing hernioplasty. Aim- The aim of the study was to compare the merits of intrathecal adjuvants fentanyl/nalbuphine hydrochloride when added to 0.5% hyperbaric bupivacaine in patients undergoing hernioplasty under spinal anaesthesia. Methods- Totally 120patients undergoing elective hernioplasty surgery were included in this study. They all were allocated into three groups of forty patients each randomly. Nalbuphine Group (A) 0.5ml of nalbuphine hydrochloride (500μg), Fentanyl group(B) 0.5ml of fentanyl (25μg), Control group (C) 0.5ml of Normal saline, were added as adjuvants to 3ml of 0.5% hyperbaric bupivacaine. Sensorimotor block onset time and duration, highest sensory level blockade and time to reach it, two segment regression of sensory level blockade and duration of analgesia were studied. Results: Onset time of a sensory block in Control group (C) 4.08 ±1.25 mins>Nalbuphine Group (A) 3.05 ±0.88mins >Fentanyl Group (B) 2.25 ±0.63 mins. Onset time of a motor block in Control Group (C) 3.43 ±0.93 mins>Nalbuphine Group (A) 2.33 ±0.69 mins> Fentanyl Group (B) 1.48 ±0.51 mins. Time to reach a highest sensory block in Control Group(C)14.54 ±3.54 mins>Nalbuphine Group (A)13.75 ±2.06 mins>Fentanyl Group(B) 11.68 ±2.44 mins. Duration of analgesia in Nalbuphine Group (A)5.15 ±0.350 hours>Fentanyl Group (B) 4.05 ±0.539 hours> Control Group(C) 2.64 ±0.349 hours. The onset of sensory and motor blockade, time to reach the highest sensory level was prolonged in the nalbuphine group. The duration of sensory blockade, two segment regression of sensory block, and duration of analgesia were prolonged in the nalbuphine group than fentanyl group. The number of patients to reach highest sensory level T2-T4 was more in nalbuphine group. Conclusion: Comparing intrathecal adjuvants Nalbuphine and Fentanyl concludes that: Intrathecal Nalbuphine may be a good alternative to Fentanyl in surgeries like hernioplasty and in below umbilical surgeries which provides an extended sensorimotor blockade, and increased duration of analgesia without any adverse effects.
Authors and Affiliations
Amutharani . , J Bridgit Merlin, A Govishkamal, Heber Anandan
Keywords
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- EP ID EP521135
- DOI 10.26611/1015931
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