698.16961 Original Article Anaesthesia Section Analgesic Effect of Intrathecal Nalbuphine in Comparison with Fentanyl as an Adjuvant with Hyperbaric Bupivacaine (0.5%) during Spinal Anaesthesia in Lower Abdominal Surgery: A Double-blinded Randomised Clinical Study (original) (raw)
Related papers
Intrathecal Nalbuphine vs Fentanyl with Hyperbaric Bupivacaine for Postoperative Analgesia
Journal of Medical Science And clinical Research, 2018
Regional anaesthesia for gynaecological procedures has emerged as an important technique with simplicity, rapid onset of action, good muscle relaxation, and safety as its added advantage. A study was designed to compare effects of intrathecal Nalbuphine and fentanyl to hyperbaric bupivacaine for gynaecological surgeries. Material and Method: 60 patients, 20 to 60 years of age, BMI < 35 kg/m 2 , ASA grade I and II were divided into two groups. Grp N received Inj. Bupivacaine 0.5% (H) 3 ml (15mg) + Inj. Nalbuphine 1mg in 0.5 ml NS [Total volume 3.5 ml] Group F received Inj. Bupivacaine 0.5% (H) 3ml (mg) + Inj. Fentanyl 25 µg [Total volume 3.5 ml] They were studied for onset and duration of sensory block, onset and duration of motor block, level of intra-operative sedation and postoperative analgesia with intraoperative haemodynamic stability. Results: Time of onset of sensory block was significantly longer in Group N (267± 36.68 sec) as compared to Group F(212± 39.42 sec). The mean time for onset of motor block in Group N (353.67± 45.37 sec) was significantly longer than Group F (296.67±39.42) (p<0.0001).Mean time required for two segment regression was significantly higher (P value =0.003) in Group N(108.17±10.33min) than Group F(101.40± 6.17min). Duration of postoperative analgesia was significantly longer in Group N (288.33± 22.06) min. as compared with Group F (234.00 ± 20.32) min. No significant side effects or complications were observed during the study. Conclusion: Addition of Nalbuphine shows early onset of sensory and motor block with prolonged duration of intraoperative and postoperative analgesia and hemodynamic stability.
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.
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.
Intrathecal Nalbuphine an Addition to Anaesthesia Armamentarium to Prolong Postoperative Analgesia
International Journal of Current Research and Review, 2020
Background: Nalbuphine is a synthetic opioid. It has mixed agonist-antagonist action. When used as an adjuvant to intrathecal bupivacaine it acts on kappa receptors in the dorsal horn of the spinal cord producing analgesia. We aimed the present study to evaluate the effectiveness of intrathecal nalbuphine as an adjuvant. At the same time, the efficacy of nalbuphine for sensorimotor characteristics and postoperative analgesia was also judged. Method: A total of 100 patients were enrolled. They were randomly allocated into two equal groups. Group B: received 15 mg hyperbaric bupivacaine (3ml) 0.5% + 0.5ml normal saline and Group BN: received 15 mg hyperbaric bupivacaine (3ml) 0.5% + Inj. Nalbuphine 500μg (0.5ml). The sensorimotor characteristics, duration of effective analgesia, any hemodynamic alterations, and side effects were noted. Results: The sensory and motor block characteristics were significantly faster in group BN than group B. The duration of sensory and motor block, as well as duration of effective analgesia, was significantly prolonged in group BN in comparison with group B. Quality of analgesia during the procedure was excellent in 90% and 94% in group B and BN, respectively. Sedation score, hemodynamic parameters, and respiratory rate changes were comparable between both groups. In group B, 4% patient complained of nausea/vomiting, intraoperative hypotension noted in 4% and post-dural puncture headache was recorded in 1 patient while in group BN bradycardia was observed in 3 patients. Conclusion: Addition of 500μg of nalbuphine as an adjuvant to hyperbaric bupivacaine 0.5% for spinal anaesthesia provides excellent analgesia with a longer duration of effective analgesia in comparison to intrathecal hyperbaric bupivacaine 0.5% alone.
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.
Background:Nalbuphine is a synthetic opioid with mixed agonist-antagonist action, when added as adjuvant to intrathecal bupivacaine acts on kappa receptors in the dorsal horn of the spinal cord producing analgesia. Aim:To evaluate the onset of sensory block, hemodynamicchanges, duration and quality of analgesia, and adverse effects of different doses of nalbuphine with bupivacaine for spinal anesthesia. Materials and Methods:Randomized double blind study done on 90 patients undergoing lower abdominal and lower limb orthopedicsurgeries under subarachnoid block. Patients were randomly allocated to three groups receiving either intrathecal 12.5 mg of bupivacaine + 0.5 mL normal saline alone or 12.5 mg of bupivacaine with either of nalbuphine 0.4 or 0.8 mg. Conclusion:Addition of 0.4 mg of nalbphine to 0.5% bupivacaine for subarachnoid block provides excellent analgesia with long duration of action compared with 0.8 mg of nalbuphine with minimal side-effects.
Assessment of Postoperatively Analgesia Through 0.9 MG Also 0.7 MG Intrathecal Nalbuphine
2019
Objectives: Intrathecal opioids offer very calm also effectual technique of extending postoperatively analgesia owing to their achievement on spinal opioid receptors. Nalbuphine remains the diverse opioid agonist-antagonist that got improved side effect outline as compared to morphine. This remains very effortlessly accessible in Bangladesh deprived of the requirement for narcotics license. Methodology: This existing research was conducted at Lahore General Hospital Lahore from September 2018 to March 2019. Overall seventy respondents experiencing numerous inferior stomachs also inferior limb operations remained randomized into 3 sets also established moreover 0.9 mg or 0.7 mg intrathecal nalbuphine by 2.3 ml of 0.6% hyperbaric bupivacaine. The period of postoperatively analgesia, hemodynamic constancy also occurrence of opposing properties remained distinguished. Results: The average period of postoperatively analgesia in 0.9 mg also 0.7 mg set remained 248 ± 13 also 238 ± 12 minutes correspondingly (p = 0.008). The occurrence of bradycardia remained additional in 0.7 mg set but then again did not influence statistical implication. The incapability of developed quantity to attain lengthier analgesia may remain owing to the ceiling result also anti-analgesic activities of nalbuphine. Conclusion: The quantity of 0.9mg of nalbuphine by way of an intrathecal adjuvant appears to stay optimal for offering lengthy pole-operatively painlessness by negligible side effects.
Background: Spinal anaesthesia is a commonly employed technique which provides safe, effective, low cost surgical anesthesia with good post-operative analgesia. Nalbuphine is a semi synthetic opioid with mixed antagonist and k agonist properties. In present study we have compared 0.8mg vs 1.4mg of Intrathecal inj. Nalbuphine with inj. bupivacaine heavy 0.5% 3.5cc to determine the most optimal dose for effective anaesthesia and maximum postoperative analgesia in lower abdominal surgeries. We also observed about the common side effects that occur with opioids like, pruritus, nausea, vomiting, sedation. Material and Methods: Patients were randomly allocated into two groups of 30 participants each. They received either nalbuphine 0.8 mg (group A) or nalbuphine 1.4 mg (group B) diluted upto 0.5ml with normal saline, mixed with 17.5 mg of hyperbaric bupivacaine 0.5% (3.5 ml). The onset of sensory blockade, onset of motor blockage, duration of sensory blockade, two-segment regression time from highest level of sensory blockade and duration of motor blockade were recorded following procedure. Results: In this study, we found that intrathecal injection Nalbuphine combined with intrathecal bupivacaine provides faster onset of sensory and motor blockage along with intraoperative hemodynamic stability. Addition of 1.4 mg intrathecal Nalbuphine in comparison with 0.8 mg provides better postoperative analgesia. The duration of sensory and motor blockade were increased without significantly increasing the incidence of side effects such as sedation, pruritus, nausea/vomiting and respiratory depression. Conclusion: In conclusion, Intrathecal Nalbuphine (1.4mg) added to Intrathecal Bupivacaine 0.5% heavy (17.5mg) provides prolonged postoperative analgesia without increasing risk of side effects. Further studies are required to determine optimal dosage of intrathecal Nalbuphine.
Background & Objectives: Intrathecal opioids provide an easy and efficient method of prolonging postoperative analgesia due to its action on the spinal opioid receptors. Nalbuphine is a mixed opioid agonist-antagonist which has better side effect profile than morphine. It is easily available in India without a need for narcotics license. The optimal dose of nalbuphine as an adjuvant to intrathecal bupivacaine is not known, as the availability of other narcotics, e.g. fentanyl, sufentanyl etc., in the West has diminished the need to use, and thus to research partial opioids like nalbuphine.
Regional Anesthesia and Pain Medicine, 2007
Background: The purpose of this randomized, double-blind, placebo-controlled trial is to study the effect of adding various doses of fentanyl to 2.2 mL of bupivacaine (0.5% hyperbaric), for spinal anesthetic in nonobstetric population undergoing superficial lower abdominal surgery (hernia repair). Methods: A population of 60 patients belonging to ASA classes I and II, scheduled for elective inguinal hernia repair, were randomized to receive a spinal anesthetic with 2.2 mL of bupivacaine (0.5% hyperbaric) and saline (control group), or fentanyl 10, 20, 30, or 40 g. The volume of injected drug was kept constant at 3 mL by adding preservative-free saline for blinding purposes. Subarachnoid block characteristics, drug-related side effects, and postoperative analgesia requirements were assessed and recorded. Results: Significant improvement in quality and duration of analgesia ocurred in treatment groups (receiving fentanyl and bupivacaine) compared with the control group (saline and bupivacaine) (P Ͻ .05). However, no improvement in analgesia occurred when the dose of fentanyl added was increased from 10 to 20, 30, or 40 g. Conclusions: The data suggest that in a nonobstetric population receiving spinal anesthetic for superficial lower abdominal surgery (hernia repair), addition of 10 g fentanyl to bupivacaine 0.5% (hyperbaric) significantly improves the quality and duration of analgesia. No further advantage occurs if the dose of fentanyl is increased up to 40 g.