Table of Contents

2019 Month : March Volume : 8 Issue : 12 Page : 830-834

A RANDOMIZED COMPARATIVE STUDY TO ASSESS THE EFFECT OF INTRATHECAL NALBUPHINE VERSUS INTRATHECAL FENTANYL AS ADJUVANT TO BUPIVACAINE FOR LOWER LIMB ORTHOPAEDIC SURGERY.

Debabrata Nath Sharma1, Manmaya Padhy2, Monali Kar3

Corresponding Author:
Manmaya Padhy,
Shakti Nagar, 3rd Lane Extension,
Lochapada Road, Berhampur,
Odisha, India.
E-mail: manmayapadhy52@gmail.com

ABSTRACT

BACKGROUND

In lower limb orthopaedic surgery, post-operative pain management is a major issue as spinal anaesthesia provides short duration analgesia. Many adjuvants like opioids are added to prolong the effects of spinal anaesthesia. we wanted to determine the better additive (fentanyl/nalbuphine) for bupivacaine for lower limb orthopaedic surgery by comparing nalbuphine (1 mg) with fentanyl (25 µg) as intrathecal adjuvants to 0.5% hyperbaric bupivacaine in patients undergoing elective lower limb orthopaedic surgery.

MATERIALS AND METHODS

This study is a double blinded randomized controlled trial conducted at MKCG Medical College, Berhampur from April 2018 to October 2018. Patients scheduled for elective lower limb orthopedic surgery under subarachnoid block were enrolled. Sample size was 30 per group. Intervention (A) group received 3 ml (15 mg) of 0.5% bupivacaine with 0.5 ml of nalbuphine (1 mg) intrathecally and control (B) group received 3 ml of 0.5% bupivacaine with 0.5 ml of fentanyl (25 mg). The outcome variables were- onset of sensory and motor blockade, duration of sensory and motor blockade, duration of analgesia, intra-operative hemodynamic changes and adverse effects like sedation, pruritus, nausea and vomiting. Data was analysed with SPSS, and independent sample t test was applied.

RESULTS

There was no significant difference in onset of sensory and motor blockade between the two groups. Duration of sensory blockade was significantly prolonged (112.6 ± 8.3 min) in group A than in group B (103.7 ± 7.5 min) and duration of motor block was significantly extended in patients of Group A (155.7 ± 16.8 min) than group B (133.1 ± 12.4 min). The duration of effective analgesia was significantly more in group A than group B. There was no significant difference in sedation score between two groups. There was no occurrence of intraoperative nausea, vomiting, respiratory depression, shivering or supplemented analgesia.

CONCLUSION

Nalbuphine (1 mg) as intrathecal adjuvants to 0.5% hyperbaric bupivacaine increases the duration of sensory block, motor block and the effective analgesia time more efficiently than fentanyl in patients scheduled for elective lower limb orthopedic surgery under subarachnoid block.

KEY WORDS

Nalbuphine, Randomised Control Trial, Bromage Scale, Bupivacaine, Sensory Regression

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