Evaluation of the Efficacy of Intrathecal Fentanyl Versus Intrathecal Nalbuphine as Adjuvants to 0.75% Ropivacaine for Post-operative Pain Relief in Cesarean Section: A Double-blind Randomized Comparative Study
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2017, Vol 5, Issue 1
Abstract
Abstract Background: Spinal anesthesia is safe, simple to perform, and also has many advantages such as intense analgesia and awake mother to permit bondage between mother and the newborn. Nalbuphine is a mixed agonist–antagonist opioid and has a potential to attenuate the μ-opioid effects and to enhance the kappa-opioid effects. It produces desirable analgesia without causing the undesirable side effects of a mu agonist. Hence, the aim of this study is to compare the efficacy of intrathecal fentanyl versus intrathecal nalbuphine when added to isobaric ropivacaine for spinal anesthesia in cesarean section patients. Aim: The aim of the study is to evaluate the efficacy of intrathecal fentanyl versus intrathecal nalbuphine as adjuvants to ropivacaine for post-operative pain relief in cesarean section patients. Materials and Methods: After Institutional Ethics Committee approval and written informed consent, 50 pregnant females of ASA Grade II presented to Rangaraya Medical College for elective cesarean section were enrolled for this randomized, double-blinded comparative study. Group RF (n = 25) was given intrathecal injection of 2 ml isobaric 0.75% ropivacaine + 25 mg (0.5 ml) fentanyl (fentanyl 1 cc = 50 mg). Total volume made up to 2.5 ml. Group RN (n = 25) was given intrathecal injection of 2 ml of 0.75% isobaric bupivacaine + 1 mg (0.1 ml + 0.4cc NS) nalbuphine (nalbuphine 1 cc = 10 mg, 0.1 cc = 1 mg is made to 0.5 ml with normal saline) total volume made up to 2.5 ml. After performing the spinal injections, the following parameters were (noted) recorded. The onset times of sensory block to T8 and motor block (MBO) to MB2 using pinprick and modified Bromage scale, respectively. Time to first request of analgesia, i.e., time from administering intrathecal drug to time at which the patient demands rescue analgesia for post-operative pain is defined as the duration of analgesia. Post-operative hemodynamics were recorded continuously. Level of consciousness, respiratory depression, and pulse oximetry were continuously monitored up to initial 24 hours post-operative period. The data were analyzed statistically. Results: (1) Duration of sensory blockade was also significantly prolonged in RN group (RF vs. RN 180.75 ± 34.27 vs. 263.63 ± 44.88); P < 0.0186 was considered statistically significant, (2) the duration of motor blockade was significantly higher in nalbuphine group (RF vs. RN 148.13 ± 23.09 vs. 220 ± 34.59) P < 0.0002, (3) the time to first request of analgesia was significantly prolonged in nalbuphine group (RF vs. RN: 233.88 ± 36.82 vs. 312.38 ± 65.48); P < 0.01 was considered statistically significant. Keywords: Fentanyl, Nalbuphine, Sensory blockade, Spinal anaesthesia
Authors and Affiliations
K Vijayendrakumar Babu
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