Abstract
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/m2, 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.
References
- Shehlashakooh, Pooja bhosle. Intrathecal Nalbuphine: an effective adjuvant for post operative analgesia. April (2014) 79-82.
- Seewal R, Shende D, Kashyap L et al. Effect of addition of various doses of Fentanyl intrathecally to 0.5% hyperbaric bupivacaine on perioperative analgesia and subarachnoid block characteristics in lower abdominal surgery: a dose-response study. Reg Anesth Pain Med. 2007; 32(1): 20-6.
- Vaghadia H, McLeod DH, Mitchell GW, Merrick PM, Chilvers CR. Small dose hypobaric lidocaine Fentanyl spinal anaesthesia for short duration outpatient laparoscopy. II. Optimal Fentanyl dose. Anesthanalg 1997:84: 65-70.
- Michael RM, Mehta M. Comparison between dexmedetomidine and Nalbuphine as an adjuvant to bupivacaine in spinal anaesthesia. International Journal of Advanced Research.2016 Jan; S3(1):1024-45
- Xavier Culebra, Giovanni Gaggero, Jiri Zatloukal, Christian kern and Rene-Andre’as Marti. Advantages of intrathecal Nalbuphine, compared with intrathecal morphine, after Caeserian delivery: An Evaluation of Postoperative Analgesia and adverse effects. Anesth Analg 2000;91:601-605
- ArghyaMukharjee, Anirban Pal, Jitendra Agrawal, Amrita Mehrota, Nidhi Dawar: Intrathecal Nalbuphine as an adjuvant to subarachnoid block: what is the most effective dose. Vol5, 2011,I(2), page 171-175
- Swati Bisht MD, Rashmi Dubey MD. Comparison of intrathecal Fentanyl and Nalbuphine-A prospective randomized controlled study in patients undergoing total abdominal hysterectomy. Anaest-hesia, Pain and Intensive Care (APICARE);2017
- Gupta K, Rastogi B, Gupta PK, Singh I et al. Intrathecal Nalbuphine versus intrathecal Fentanyl as adjuvant to 0.5% hyperbaric bupivacaine for orthopedic surgery of lower limbs under subarachnoid block: A comparative evaluation. Indian Journal of Pain. 2016;30(2):90
- Saxena A, Arava S. Current concepts in neuraxial administration of opioids and non-opioids: An overview and future perspectives. Indian Journal of Anaesthesia 2004; 488(1): 13-24.
- Ravikiran J Thote, Prashant Lomate et al. Comparison among Intrathecal Fentanyl and Nalbuphine in combination with bupivacaaine and plain bupivacaine for lower limb surgeries. Volume 14, Issue 2, 2015 pp 361-366
- Jaideep Singh, Aditya Agarwal et al. Intrathecal Nalbuphine an effective Adjuvant for Postoperative Analgesia( A comparative study with Fentanyl). Indian Journal of Contemporary Medical Research; Volume 4; Issue 1, Jan 2017.
Corresponding Author
Dr Narendra Bande
Plot No. 379, At+Post- Narkhed, Dist- Nagpur
Maharashtra, 441304, GMC Aurangabad, India
Mob No.9405916059, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.96
