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Category: Volume 06 Issue 04 April 2018
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Title: A Comparative Study of Dexamethasone and Nalbuphine addition to Levobupivacaine for Sciatic Nerve Block for Post-Operative Analgesia in Orthopaedic Surgery

Authors: Dr Jitendra Agrawal, Dr Ajay Singh, Dr Bhanu Choudhary, Dr Rakhi Agrawal, Dr Vaibhav Gupta, Dr Mirza Aabid Beg

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.31

Abstract

Background: Pain is a predictable part of the postoperative experience. Unrelieved postoperative pain may result in clinical and psychological changes that increase morbidity and mortality as well as the cost and also impairs the quality of life.

Aims and Objectives: To compare postoperative analgesic effect and safety of dexamethasone or nalbuphine in addition to levobupivacaine in lower limb orthopedic surgeries.

Materials and Methods: Ninety patients of ASA grade I and II undergoing lower limb orthopaedic surgeries were studied in the Department of Anaesthesiology, GR Medical College and JA Group of Hospitals, Gwalior from December 2015 to August 2017. The patients were divided  into Group D (n= 30, were given 24 ml of 0.25% levobupivacaine hydrochloride + 1ml (4mg) of dexamethasone), Group N (n=30, were given 24ml of 0.25% levobupivacaine hydrochloride + 1 ml(10mg) of nalbuphine) and Group C (n=30, were given 24ml of 0.25% levobupivacaine hydrochloride + 1ml of normal saline). Postoperative analgesia in terms of VAS score, time to first rescue analgesic (duration of analgesia) and side effect or complication were studied in each group.

Results: Male preponderance was noted in each group (27 in Group D, 25 in Group N and 26 in Group C; p=0.749). Mean age of patients in Group D, Group N and Group C was 34.67±13.55, 37.90±10.04 and 38.93±12.54 years respectively (p>0.05). Mean pulse rate (min), SBP (mmHg), DBP (mmHg) and Sp02 (%) were comparable between groups (P>0.05).  MAP (mmHg) was significantly high in Group N compared to Group C. VAS score was 38.56±1.79 at 16 hours in Group N, whereas Group D had VAS score of 42.83±0.99 at 12 hours and Group C had 49.46±1.132 at 8 hours (p value < 0.001). At 24 hours VAS score of group N, D and C were 15.17±1.497, 15.67±1.309 and 15.67±1.714 respectively. Two patients in Group N and one patient in Group D and C experienced nausea and vomiting and one patient in Group C and N experienced postoperative shivering.

Conclusion: Nalbuphine is a good alternative for post operative pain management along with Levobupivacaine hydrocholoride compared to dexamethasone with minimal postoperative complication.

Keywords:  Orthopaedic surgery,VAS score, first rescue analgesic, dexamethasone, nalbuphine.

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Corresponding Author

Dr Ajay Singh

PG 3rd Year Student, Department of Anaesthesiology, GRMC Gwalior, MP India

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