DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20170163

Efficiency of nalbuphine as an adjuvant to bupivancaine in lower limb orthopaedic surgery-a prospective study

Kanhya Lal Gupta, Amit Gupta, . Neeraj

Abstract


Background: Spinal Anaesthesia is a well-known technique of performing lower limb orthopaedic surgeries. It has a shorter duration of action and early arising postoperative pain due to which various adjuvant needs to be added and their roles are being evaluated in various studies. Intrathecal opioids act synergistically with local anaesthetics and thus intensifying the sensory block without having any effect on sympathetic blockage. The main aim of present study is to investigate and evaluate the effectiveness of intrathecal nalbuphine (preservative free) as an adjuvant and also the efficacy of nalbuphine for postoperative analgesia and its complications if there are any.

Methods: A total of 60 patients were included in this study belonging to ASA I and ASA II score with normal coagulation profile. Patients were randomly divided into 2 groups of 30 patients each. Group I receiving 3 ml of hyperbaric bupivacaine 0.5%+1.0mgm of nalbuphine (preservative free) injection made in 0.5 ml normal saline intrathecally. Group II received 3 ml of hyperbaric bupivacaine 0.5%+0.5 ml injection Normal saline intrathecally. The following criteria were noted. The onset of sensory blockade and complete motor blockade highest level of sensory blockade, duration of sensory blockade, duration of motor and duration of effective analgesia were recorded. Any hemodynamic alterations were also noted.

Results: The mean time for the onset of sensory blockage was 56 sec in Group I and 59 sec in Group II (control). The difference were statistically insignificant (p>0.05). The mean onset of motor blockage was 106 sec in Group I and 208 sec in Group II (control). The difference was statically insignificant. The peak onset time in Group I and Group II was 372 sec and 220 sec respectively (p>0.05). Two segment regression times for sensory blockage was prolonged in Group I (118.20±8.56 min) compared to Group II (104.56±15.20 mins).

Conclusions: The duration of postoperative analgesia was 6-8 hours in Group I compared to 3-4 hours in Group II (p value= 0.0001, statistically significant).

Keywords


Bupivancaine, Efficiency, Nalbuphine

Full Text:

PDF

References


Rudra A, Halder R, Sen A, Kundu S. Efficacy of low dose propofol for control of emetic episodes during cesarean delivery with spinal anesthesia. Indian J Anesth. 2004;48:31-4.

Bogra J, Arora N, Srivastava P. Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for caesarean section. BMC Anesthesiol. 2005;5:5.

Ahluwalia P, Ahluwalia A, Varshney R, Thakur S, Bhandari S. A Prospective Randomized Double-Blind Study to Evaluate the Effects of Intrathecal Nalbuphine in Patients of Lower Abdominal Surgeries under Spinal Anaesthesia. Inter J Scie Study. 2015;3(3):19-23.

Tan PH, Chia YY, Lo Y, Liu K, Yang LC, Lee TH. Intrathecal bupivacaine with morphine or neostigmine for postoperative analgesia after total knee replacement. Can J Anesth. 2001;48(6):551-6.

Eisenach JC, Carpenter R, Curry R. Analgesia from a peripherally active Kappa opioid receptors agonist in patients with chronic pancreatitis. Pain. 2003;101:89-95.

Charuluxananan S, Kyokong O, Somboonviboon W, Lertmaharit S, Ngamprasertwong P, Nimcharoendee K. Nalbuphine versus propofol for treatment of intrathecal morphine induced pruritus after cesarean delivery. Anesth Analg. 2001;93:162-5.

Jyothi B, Gowda S, Shaikh SI. A comparison of analgesic effect of different doses of intrathecal nalbuphine hydrochloride with bupivacaine and bupivacaine alone for lower abdominal and orthopedic surgeries. Ind J Pain. 2014;28(1):18.

Gomaa HM, Mohamed NN, Zoheir HA, Ali MS. A comparison between post-operative analgesia after intrathecal nalbuphine with bupivacaine and intrathecal fentanyl with bupivacaine after cesarean section. Egyp J Anaesth. 2014;30(4):405-10.

Chattopadhyay A, Maitra S, Sen S, Bhattacharjee S, Layek A, Pal S, et al. A study to compare the analgesic efficacy of intrathecal bupivacaine alone with intrathecal bupivacaine midazolam combination in patients undergoing elective infraumbilical surgery. Anesthesiol Res Pract 2013;2013:567134.

Rawal N, Nuutinen L, Lovering SL, Gobuty AH, Hargardine J, Lehmkuhl L, et al. Behavioral and histopathologic effects following intrathecal administration of butorphanol, sufentanil, and nalbuphine in sheep. Anesthesiology. 1991;75:1025-34.

Lin ML. The analgesic effect of subarachnoid administration of tetracaine combined with low dose of morphine or nalbuphine for spinal anesthesia. Ma Zui Xue Za Zhi. 1992;30:101-5.

Tiwari AK, Tomar GS, Agrawal J. Intrathecal Bupivacaine in Comparison With a Combination of Nalbuphine and Bupivacaine for Subarachnoid Block: A Randomized Prospective Double-Blind Clinical Study. Am J Ther. 2013;20(6):592-5.

Culebras X, Gaggero G, Zatloukal J, Kern C, Marti RA. Advantages of intrathecal nalbuphine compared with intrathecal morphine, after cesarean delivery: An evaluation of postoperative analgesia and adverse effects. Anesth Analg. 2000;91:601-5.

Mostafa MG, Mohamad MF, Farrag WS. Which has greater analgesic effect; Intrathecal nalbuphine or intrathecal tramadol. J Am Sci. 2011;7:480-4.