Comparison of Morphine with Nalbuphine as an Adjuvant to Caudal Bupivacaine: A Double blinded Randomized Study
Journal Title: Indian Journal of Pathology: Research and Practice - Year 2018, Vol 7, Issue 12
Abstract
Context: Caudal analgesia is the most preferred technique for pain relief in paediatric population using local anaesthetic drug along with other adjuvants such as morphine, fentanyl, nalbuphine, tramadol, clonidine. Aim: To compare the efficacy and assess the complications of morphine and nalbuphine as an adjuvant to caudal bupivacaine for postoperative analgesia. Settings and Design: It is a prospective randomized double blind control study , conducted in Melmaruvathur Adhiparasakthi Institute of Medical Sciences & Research over a period of six months from August 2017 to January 2018 after getting ethical approval. Methods and Material: Children fulfilling the inclusion criteria were randomly allocated to receive 1ml/kg of caudal bupivacaine 0.25% either with morphine 50ug/kg (group M ) or nalbuphine 0.2 mg/kg (group N) following general anaesthesia. Post operative pain scores assessed using FLACC score and sedation using Modified Wilson scoring. Complications such as respiratory depression, vomiting, & pruritis were also noted. Statistical analysis used: Statistical analysis was performed using appropriate test with Graphic prism 5.0 software. Results: Two groups are comparable in age, sex & weight. The post operative pain scores were less in group M compared to group N and they are statistically significant (p<0.05) only at 0 (0.500±0.124 vs 0.866±0.114), 1 (0.667±0.66 vs 1.200±0.78) & 2 (1.400±0.498 vs 2.000±0.830) hours but they were not statistically significant at 4 (2.133±0.776 vs 2.567±1.006), 8 (3.400±0.959vs 4.200±1.003), & 12 hours (5.733±0.827 vs 6.500±1.841). Requirement of rescue analgesic were significantly longer in group M (11.93±1.98 hrs) compared to group N (9.150±1.29) and they are statistically significant (p< 0.05). Post operative sedation score are statistically significant between two groups. Conclusions: As an adjuvant to bupivacaine ,morphine has prolonged the duration of analgesia and decreased the use of rescue analgesic for around 12 hours but at this therapeutic dose, it is associated with higher life threatening complications such as respiratory depression, and other complications like nausea and vomiting whereas Nalbuphine has decreased the use of rescue analgesic for more than 8 hours and has not produced above mentioned complication . Hence the usage of morphine as an adjuvant can be replaced with nalbuphine in Pediatric surgeries.
Authors and Affiliations
Prasath Chandran
Keywords
Related Articles
- EP ID EP534915
- DOI 10.21088/ijaa.2349.8471.5718.13
- Views 90
- Downloads 0
Blood Donor Deferral Pattern at Tertiary Care Center
Background and Objectives: It is well known that quite a large number of apparently healthy donors are not able to donate blood successfully because of varied reasons. These donors are deferred temporarily or permanently...
Staff Nurses’ Knowledge of Blood Transfusion and Its Impact on Key Performance Indicators of Blood Components Administration: Can We Bridge the Gap?
Context: Due to increasing demand for blood components, injudicious utilisation of blood products will definitely have serious implications in resource constrained settings. The staff nurses should be fully aware of all...
Anemia and Biochemical Profile of Thalassemia Patients
Context: Thalassemia is a group of inherited hemoglobin disorders characterized by reduced synthesis of one or more of the globin chains leading to imbalanced globin synthesis which is the major factor in determining the...
A Study of Sperm Morphology in Cases of Varicocele
Background: Varicocele is the most common treatable cause of male infertility affecting the young couple’s Varicocele is associated with increased incidence of abnormal sperm abnormalities including sperm count, sperm co...
Use of Platelet Indices in the Differential Diagnosis of Hypo-Productive and Hyperproductive Thrombocytopenia in Children
Background: Platelets are essential for maintaining the integrity of the endothelium and for controlling hemorrhages when the injury to the blood vessels occurs. A low platelet count is a common entity encountered by the...