A Comparative Study of Analgesic Effect of Intrathecal Nalbuphine and Fentanyl as Adjuvant in Lower Limb Orthopaedic Surgery (original) (raw)
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Journal of Evolution of Medical and Dental Sciences, 2019
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.
"For all the happiness mankind can gain, is not in pleasure, but in rest from pain." -John Dryden Alleviation of pain is one of the most fundamental goals in anesthesiology. Postoperative pain, apart from patient's suffering, has many other adverse physiological and psychological effects like respiratory depression, circulatory disturbances and metabolic stress responses induced by anesthesia and surgery. Thus, postoperative pain management plays a vital role in deciding the overall outcome of any surgery.
Cureus
Background: Spinal anaesthesia is the most commonly used technique for lower limb orthopaedic surgeries as it is economical and easy to administer. Opioids as adjuvants to local anaesthetics during spinal anaesthesia have played a vital role in reducing post-operative pain qualitatively and effectively. Methods: This prospective randomised study was conducted on 100 patients divided into two groups scheduled for lower limb orthopaedic surgeries. Group bupivacaine fentanyl (BF) received 25 mcg of fentanyl with 15 mg of bupivacaine and Group bupivacaine nalbuphine (BN) received 1 mg of nalbuphine and 15 mg of 0.5% bupivacaine. The aim of the study was to compare the analgesic efficacy of intrathecal fentanyl and nalbuphine as an adjuvant to hyperbaric bupivacaine for spinal anaesthesia. Duration of effective analgesia, haemodynamic parameters, onset and duration of sensory and motor block, adverse effects, and visual analogue scale (VAS) score were assessed. Results: Duration of effective analgesia was 388±24.88 minutes in the BN group and was higher (p-value <0.001) in comparison to the BF group, which was 304.70±15.76 minutes. Conclusion: Nalbuphine was more effective than fentanyl in providing post-operative analgesia when used as an adjuvant to hyperbaric bupivacaine.
2018
Opioids have an important place as adjuvant to local anaesthetic agents in the management of spinal anaesthesia, the most commonly used being fentanyl. Other alternatives like opioid agonist antagonist agents like nalbuphine, butorphanol and buprenorphine are now being studied as adjuvants to prolong the duration of sensory and motor block with lower incidence of opioid related side effects. 60 patients belonging to ASA status I and II of either sex were randomly divided into three groups of 30 each to receive either butorphanol25 µg (Group A) or fentanyl 25 mcg (Group B)) with 2.5 mL 0.5% hyperbaric bupivacaine, making intrathecal drug volume to 3mL in each group.. Sensory and motor block characteristics in terms of time to onset and duration were recorded for each group. Drug-related side effects of pruritus, nausea/vomiting, and respiratory depression were also recorded. The two groups were comparable regarding the demographic profile. The fentanyl group showed delayed onset of sensory block (274 ± 73.39 sec) as well as a longer duration of sensory block (145.07 ± 5.34 mins vs 141.33 ± 3.51) than butorphanol. The duration of motor block was also prolonged in the fentanyl group(149 ± 7.13 vs 140.37 ± 2.31). Both the findings were significant. Butorphanol provided a significantly longer duration of postoperative analgesia (250.10 ± 4.05 vs 244 ± 7.11 min). No drug related side effects were observed in either group. Addition of 25 μg of butorphanol as adjuvant to hyperbaric bupivacaine 0.5% provides a faster onset of sensory block as compared to 25 μg fentanyl. Fentanyl provided a significantly greater duration of both sensory and motor block than butorphanol. The duration of postoperative analgesia was significantly greater with butorphanol.
Mansoura Medical Journal, 2016
Introduction: Intrathecal fentanyl is routinely mixed with hyperbaric bupivacaine during spinal block, but this may alter the baricity of both drugs and hence affect their spread and action. Aim: This study aimed to compare the sequential administration of intrathecal fentanyl and bupivacaine to the routine mixing of the two drugs as regard the block characteristics, the postoperative analgesia duration, and the adverse effects. Methods: Current prospective, controlled, randomized trial was carried out on 100 adult participants subjected to lower limb orthopedic surgeries under spinal anesthesia. Subjects were allocated randomly into two equal groups (50 each). Group P: received premixed solution of hyperbaric bupivacaine (HB) 0.5 % (12.5 mg) plus 25 µg of fentanyl in the same syringe and group S: received 25 µg of fentanyl followed by 12.5 mg of HB in sequential manner. Block characteristics, time to the first rescue pethidine request, number of participants who requested for pethidine within the first 6 postoperative hours, and adverse effects were assessed. Results: Group S patients had statistically significantly faster onset of both sensory (4.58 ± 1.5 vs 5. 40 ± 1.8 min, p = 0.02) and motor block (5.79 ± 1.5 min versus 6.64 ± 1.9 min, p = 0.01), shorter time to achieve the highest sensory level (6.12 ± 1.96 min vs 8.77 ± 2.5min, p = 0.00), and a longer time till the first postoperative rescue analgesic need (252.26 ± 39.3 min versus 234.70 ± 40.2 min, p = 0.03). Group P patients achieved statistically significantly higher level of sensory blockade and showed longer sensory block duration (216.30 ±30.8 vs 199.44± 23.8, p = 0.003). Adverse effects were comparable in both groups. Conclusions: The sequential administration of fentanyl and hyperbaric bupivacaine improves the spinal block characters in patients subjected to lower limb orthopedic surgeries with comparable adverse effects profile in comparison to mixing both drugs.
F1000Research
Background: Sub-arachnoid block or spinal anaesthesia is a common mode of anaesthesia that is used for lower limb orthopaedic surgeries. Bupivacaine hydrochloride is a long-acting amide anaesthetic used extensively intrathecally. It has the ability to effectively block sensory and motor pathways. However, it has drawbacks, like cardiotoxicity and neurotoxicity. Ropivacaine is a long-acting amide local anaesthetic agent. It has the capacity to block sensory nerves more than motor nerves. Ropivacaine has reduced potential for neurotoxicity and cardiotoxicity. Fentanyl is a synthetic opioid. It can be added as an adjuvant to local anaesthetic agents used intrathecally. Fentanyl is characterised by its high potency, rapid serum elimination, and minimal histamine release. The blood-brain barrier can be quickly crossed by fentanyl, which takes one to two minutes to generate analgesia. Objectives: To compare post-operative analgesia in patients receiving bupivacaine with fentanyl and ropiv...
Zenodo (CERN European Organization for Nuclear Research), 2023
Background:The shorter duration of action of typical local anaesthetics used for spinal anaesthesia demands the early need for postoperative analgesia. Epidural analgesic administration reduces the stress reaction to pain and surgery, reduces the requirement for systemic analgesics, and promotes early rehab. 1 It was discovered that using opioids as an adjuvant to local anaesthetics has synergistic effects. The advantages of this combination were improved pain alleviation, motor sparing, and less toxicity. 2 Objective:To compare the efficacy of epidural analgesia by using fentanyl and nalbuphine as adjuvants along with bupivacaine following lower limb surgeries with respect to Onset, Duration, and side effects. Meterials and Methods:Prospective randomized doubled blind comparative study would be conducted on 60 adult patients of ASA grade I & II in the age group of 18 to 59 years of either sex, posted for lower limb surgeries after taking informed written consent. Patients were randomly divided on an alternative basis into 2 groups of 30 each. In study conducted in AL-AMEEN MEDICAL COLLEGE. VIJAYAPUR, KARNATAKA during the period of April 2021 to December 2022. If visual analogue score is more than one ,GROUP A: Patient received 50ug of fentanyl + 2.5 ml 0.5% bupivacaine diluted to 10ml with distilled water given epidurally (0.125%). GROUP B: Patient received 5mg of nalbuphine +2.5 ml 0.5% bupivacaine diluted to 10ml with distilled water given epidurally (0.125%).. Noting onset and duration analgesia also monitoring of patients SBP,DBP,SpO2,RR,VAS score till 15 min followed by 30 min,1hr ,2hr,4hr ,6hr,8hr is done and asked for any side effects like nausea ,vomiting, pruritis ,sedation and urinary retention.
Post Operative Analgesia: A Prospective, Comparative Study With Intrathecal Nalbuphine And Fentanyl
Introduction: Post operatively Various adjuvants have been used along with local anaesthetics for prolongation of analgesia post operatively in neuraxial blockade. Opioids are most commonly used analgesics for managing postoperative pain. The aims of the present study was to compare the efficacy and safety of nalbuphine and fentanyl for postoperative pain relief in surgical procedure. Nalbuphine is an opioid drug with mixed μ antagonist and κ agonist properties. Materials and methods: Ninety patients who were posted for various surgical procedures belonging to ASA I & II were taken into the study. They were assigned randomly into two groups, group A and group B, each group has allocated 45 patients each (n=45). Group A received nalbuphine 0.25 mg\kg and Group B received and fentanyl 1.5 ug\kg before 5 minutes of induction of anesthesia .The patient observed for recovery criteria, post-operative analgesia, and side effects. Results: The duration of post-operative analgesia and the effective analgesic time were more prolonged in Group A than in Group B with no statistically significant difference. No significant differences were found in recovery from anesthesia. No significant side effects were found among two groups. Conclusion: Nalbuphine is a better adjuvant than Fentanyl because of its prolonged post operative analgesia and effective analgesia time and lesser side effects for intrathecal injections in surgeries undergoing spinal anaesthesia. with no statistically significant difference.
Macedonian Journal of Medical Sciences, 2013
Background: Intrathecal opioids as adjuvants to local anaesthetics during spinal anaesthesia have been used to augment the analgesia produced by local anaesthetic agents. The aim of this study is to determine the duration of analgesia following addition of fentanyl to 0.5% hyperbaric bupivacaine during open reduction of lower limb fractures. Material and Methods: This prospective randomized study is comparing the effect of addition of 25µg of fentanyl to 10 mg of 0.5% hyperbaric bupivacaine intrathecally on sixty consecutive ASA I and II patients scheduled to undergo elective open reduction and internal fixation of lower limb fractures (ORIF) at the UCH, Ibadan. The patients were randomized into their either bupivacaine saline (SB n=30) 10 mg (2 ml) 0.5% hyperbaric bupivacaine or bupivacaine-fentanyl combination (FB n= 30) through a 25-guage Whitacre spinal needle. Quality and duration of analgesia as well as any sequelae were recorded. Result: Socio-demographic as well as operating data were comparable between the two groups. Fentanyl provided significantly longer duration of complete (239.97 ± 28.58 vs 129.17 ± 11.61), p<0.001 and effective (276.23 ± 26.21 vs 150.80 ± 10.33) analgesia than bupivacaine alone (p<0.001). The pain intensity (visual analog scale [VAS]) at the time to first post-operative analgesic dose in the Fentanyl-Bupivacaine (FB) groups was significantly lower than in the group BS (p<0.001). Eight of the patients in the control group BS (26.67%) group had hypotension whereas six patients (20%) in FB groups had hypotension that required rapid infusion of crystalloid. There was no statistical difference in the level of shivering in the two groups. No patient in either group developed respiratory insufficiency. Conclusion: Addition of 25 µg of fentanyl to 10 mg of 0.5% hyperbaric bupivacaine intrathecally for open reduction and internal fixation of lower limb fractures significantly prolonged the duration of complete analgesia as well as effective analgesia thereby reducing the need for early postoperative analgesic use without increase in severe adverse effect.