Madhu Srinivasaiah

Abstract

Aims: Unilateral spinal anaesthesia is a technique used to avoid hemodynamic changes and early recovery. Adjuvants are added to prolong post operative analgesia, this study was done to compare nalbuphine (0.8mg) and fentanyl (20µg) as adjuvants to 0.5% bupivacaine Heavy in unilateral spinal anaesthesia for patients undergoing lower limb orthopaedic surgeries. Settings and Design: Randomized double blind study in patients posted for lower limb orthopaedic surgery in a teritiary care center. Materials and Methods: Unilateral spinal anaesthesia was given to 68 eligible patients undergoing lower limb orthopaedic surgery with nalbuphine (0.8mg) and fentanyl (20µg) as adjuvants to 0.5% bupivacaine Heavy. Block characterstics, unilaterality, hemodynamic changes and recovery were noted. Statistical Analysis used: Independent sample t-test was used to compare continuous variables with normal distribution and chi square test for categorical variables Results: Unilateral block was seen in 60 of 68 patients enrolled. Time to achieve T 10 level was comparable between both the groups in nalbuphine and fentanyl group (4.33±0.99 and 4.77 ± 0.89 respectively). Duration of sensory block was significantly lesser in nalbuphine group as compared to fentanyl group (170.67±15.34 and 178.83±15.04 respectively). However, there was no significant difference in duration of analgesia, 265.17 ± 17.73 in nalbuphine group and 260.23 ±31.03 in fentanyl group (p=0.45). Conclusions: Nalbuphine due to its easy availability can be used as effective alternative to fentanyl as adjuvant in unilateral spinal anaesthesia.   Keywords: Bupivacaine, Nalbuphine, Fentanyl, Unilateral spinal anaesthesia

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Abstract

Aims: Hemodynamic changes caused by laryngoscopy, endotrachial intubation and creation of pneumoperitonium in laparoscopic surgeries is deleterious to patients. This study was done to compare nalbuphine an agonist antagonist opioid with fentanyl, a gold standard opioid, when used in patients undergoing laparoscopic appendectomy under general anesthesia. Materials and Methods: This study included 60 ASA I patients who underwent elective appendectomy were randomised to receive either nalbuphine 0.1mg/kg or fentanyl 2µg/kg as analgesics 5 minutes prior to intubation. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at baseline and at every 2 minutes post intubation till the end of surgery. The time of laparoscopic port insertion and creation of pneumoperitonium was noted. Independent student‘t’ test and chi square test was used to analyse continuous variables and categorical variables respectively. Results: The changes in heart rate were comparable between both groups at all time points of observation. Nalbuphine and fentanyl group showed an increase in heart rate of 3.81% and 6.03% respectively. Mean arterial pressure was comparable at all time points of observation except at the time of insertion of second port wherein fentanyl group showed 12.70% increase as compared to 4.54% fall from baseline in nalbuphine group. Side effects were comparable between both groups except sedation which was significantly more in nalbuphine group and pruritus more in fentanyl group. Conclusion: Nalbuphine due to its availability without license is an effective alternative to fentanyl in laparoscopic surgeries. Keywords: Nalbuphine, Fentanyl, Hemodynamic response, Laparoscopic surgery.

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