Intrathecal Nalbuphine an Effective Adjuvant for Post Operative Analgesia (A Comparitive Study with Fentanil)
Journal Title: International Journal of Contemporary Medical Research - Year 2017, Vol 4, Issue 1
Abstract
Introduction: Various adjuvants have been used along with local anaesthetics for prolongation of analgesia post operatively in neuraxial blockade. The frequently used adjuvants are opioids, midazolam, neostigmine, ketamine etc. Neuraxial opioids bind to intrathecal opioid receptors and produce effective pain relief post operatively with minimal untoward effects. Nalbuphine is an opioid drug with mixed μ antagonist and κ agonist properties. Thus we conducted a prospective, randomized, comparative study to observe the effect of 0.5% hyperbaric Bupivacaine 3 ml on pain relief after lower limb and lower abdominal surgeries and compare it with effect of intrathecal Nalbuphine + 0.5% hyperbaric Bupivacaine 3 ml. Material and methods: 60 patients of ASA grades I and II of either sex in the age group of 20-60 years will be randomly allocated to one of the two groups. Group B (n = 30) received 3 ml of 0.5% hyperbaric bupivacaine intrathecally; group N (n = 30) received 3 ml of 0.5% hyperbaric bupivacaine + 1 mg nalbuphine intrathecally. The onset of sensory and motor blockade, duration of motor blockade and analgesia, VAS score, haemodynamic and side effects will be recorded, tabulated, and analysed. Result: The onset of complete motor block was more rapid with fentanyl than nalbuphine and this was statistically significant (p<0.05). The duration of post-operative analgesia and the effective analgesic time were more prolonged in nalbuphine group than in fentanyl group with no statistically significant difference. As regards the side effects, they were less in nalbuphine group than the fentanyl group Conclusion: In our study we conclude that both Nalbuphine or Fentanyl in combination with low dose hyperbaric bupivacaine (15mg) are equally efficacious and haemodynamically stable in patients undergoing lower limb surgeries. However, Nalbuphine with comparatively prolonged post operative analgesia and effective analgesia time and lesser side effects is a better adjuvant than Fentanyl for intrathecal injections of Bupivacaine 0.5%(H) in surgeries undergoing spinal anaesthesia. with no statistically significant difference.
Authors and Affiliations
Jaideep Singh, Aditya Agarwal, Ajay Vatal
Keywords
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