Behavioral and Histopathologic Effects Following Intrathecal Administration of Butorphanol, Sufentanil, and Nalbuphine in Sheep

Rawal, Narinder; Nuutinen, L; Raj, Prithvi; Lovering, Sandra L.; Gobuty, A. H.; Hargardine, Judy; Lehmkuhl, Linda B.; Herva, Rita; Abouleish, Ezzat

doi:10.1097/00000542-199112000-00015

Cited by 97 publications

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“…Rawal et al in a sheep model showed that even large doses of 15-24 mg of napbuphine were not associated with hypertensive changes in spinal cord. 10 Later human studies were also conducted to test the efficacy of nalbuphine which confirmed the same results. Lin et al compared the addition of 0.4 mg intrathecal nalbupine to hyperbaric tetracaine with 0.4 mg intrathecal morphine for subarachnoid block and the results showed an improved quality of intraoperative and postoperative analgesia with fewer side effects.…”

Section: Discussionmentioning

confidence: 59%

Efficiency of nalbuphine as an adjuvant to bupivancaine in lower limb orthopaedic surgery-a prospective study

Gupta¹,

Gupta²,

Neeraj

2017

Int J Res Med Sci

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INTRODUCTIONSpinal anaesthesia is a well embraced technique for performing lower limb orthopaedic surgeries. It is simpler to perform with rapid onset of action and profound muscle relaxation. Spinal anaesthesia allows for lower drug dosage and lower incidence of failed block.1,2 Every coin has two sides. Spinal anaesthesia has a shorter duration of action and early arising postoperative pain due to which various adjuvant need to be added and their roles are being evaluated in various studies. Intrathecal administration of adjuvant drugs to local anaesthesia improves quality and duration of spinal blockage and also prolongs postoperative analgesia. Moreover, the dose and amount of local anaesthetic drugs are also reduced during subarachnoid block. 3Intrathecal opioids act synergistically with local anesthetics and thus intensifying the sensory block without having any effect ABSTRACT Background: Spinal Anaesthesia is a well-known technique of performing lower limb orthopaedic surgeries. It has a shorter duration of action and early arising postoperative pain due to which various adjuvant needs to be added and their roles are being evaluated in various studies. Intrathecal opioids act synergistically with local anaesthetics and thus intensifying the sensory block without having any effect on sympathetic blockage. The main aim of present study is to investigate and evaluate the effectiveness of intrathecal nalbuphine (preservative free) as an adjuvant and also the efficacy of nalbuphine for postoperative analgesia and its complications if there are any. Methods: A total of 60 patients were included in this study belonging to ASA I and ASA II score with normal coagulation profile. Patients were randomly divided into 2 groups of 30 patients each. Group I receiving 3 ml of hyperbaric bupivacaine 0.5%+1.0mgm of nalbuphine (preservative free) injection made in 0.5 ml normal saline intrathecally. Group II received 3 ml of hyperbaric bupivacaine 0.5%+0.5 ml injection Normal saline intrathecally. The following criteria were noted. The onset of sensory blockade and complete motor blockade highest level of sensory blockade, duration of sensory blockade, duration of motor and duration of effective analgesia were recorded. Any hemodynamic alterations were also noted. Results: The mean time for the onset of sensory blockage was 56 sec in Group I and 59 sec in Group II (control). The difference were statistically insignificant (p>0.05). The mean onset of motor blockage was 106 sec in Group I and 208 sec in Group II (control). The difference was statically insignificant. The peak onset time in Group I and Group II was 372 sec and 220 sec respectively (p>0.05). Two segment regression times for sensory blockage was prolonged in Group I (118.20±8.56 min) compared to Group II (104.56±15.20 mins). Conclusions: The duration of postoperative analgesia was 6-8 hours in Group I compared to 3-4 hours in Group II (p value= 0.0001, statistically significant).

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Section: Discussionmentioning

confidence: 59%

Efficiency of nalbuphine as an adjuvant to bupivancaine in lower limb orthopaedic surgery-a prospective study

Gupta¹,

Gupta²,

Neeraj

2017

Int J Res Med Sci

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“…160 In sheep, epidural morphine causes spinal cord necrosis 161 and intrathecal sufentanil induces inflammatory changes in the meninges. 162 In cats, intrathecal sufentanil induces inflammatory changes in the spinal cord. 103 Furthermore, these animals exhibited hindlimb dysfunction in the form of stiffness and weakness.…”

Section: Neurotoxicitymentioning

confidence: 99%

Side effects of intrathecal and epidural opioids

1995

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“…The quality of analgesia was good in patients given epidural nalbuphine 16,17,18,19 . At the end of any period of observation, more patients from group A had zero points on the VAS as compared to those from Group B.…”

Section: Discussionmentioning

confidence: 97%

A Comparative Study of Epidural Nalbuphine With Bupivacaine vs. Bupivacaine Alone in Infraumbilical Surgeries

Ramakrishnan¹,

Shunmugavelu²

2016

jemds

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BACKGROUNDAnalgesia, one of the components of triad of anaesthesia, has now extended to relief of postoperative pain, chronic pain and cancer pain. The spinal route of analgesia plays an important role in the intra and postoperative period. Effective postoperative analgesia reduces postoperative morbidity, allows early ambulation and discharge. MATERIALS AND METHODSThis study was done in 100 patients who belonged to ASA grade I & II with age of 20-60 years and underwent elective infraumbilical surgeries. After thorough aseptic precaution, L1-L2 or L2-L3 space located and using a 16 gauge Huber point Tuohy needle, epidural space was identified with loss of resistance technique. Through the epidural catheter, a test dose of 2 mL of 1% lignocaine with 10 micrograms of adrenaline was injected and finally the total dose of 15 mL of 0.5% bupivacaine with injection nalbuphine was injected through the catheter and the patients were positioned for the surgery. The pulse rate, blood pressure, respiratory rate were monitored every 5 minutes. Continuous oxygen saturation monitoring was done. At the end of surgery, patients were observed in the recovery room and in the postoperative ward. The level of consciousness assessed ever ½ hour and graded according to the sedation score. Patients were asked to mark a point scale on the 10-point visual analogue scale of pain according to the intensity of pain. The observation was done every 30 minutes. The pain relief is graded according to VAPS. OBSERVATION AND RESULTSPatients in both groups were comparable in age, duration, the site and type of surgery and baseline parameters at the starting of procedure. There were statistically no significant differences between mean age distribution, surgery performed, duration of procedure and baseline parameters in both groups. In this study, rapid onset in group A patients is due to synergistic effect of nalbuphine and bupivacaine. In case of time of onset of motor block, the actual difference between the mean is 5.04 -the study is significant (P<0.000). In the group A, the regression time was the range of 60-83 minutes with the minimum VAPS was 1 and maximum 3. Hence, the quality of analgesia was fair in 30 (85.7%) patients and good in 5 (14.3%). In the group B, the regression time was the range of 54-84 minutes and the quality of analgesia was not assessed since all of them received postoperative narcotic supplementation after the surgery. Hence, the mean duration of surgery was 61.48 minutes, and 63 minutes in Group B. In Group A, patients had sedation score with mean of 0.46 (p value 0.000) which is statically significant. In Group B, all patients were awake. There is significance in BP maintenance in group A, whereas in group B it falls below the baseline value after 5 minutes and 15 minutes and then raises after 30 min. and 45 minutes. No hypotension occurred in group A and in group B. CONCLUSIONIn our study, the epidural nalbuphine hastens the onset of both sensory and motor blockade and significantly prolonged the duration of ...

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Behavioral and Histopathologic Effects Following Intrathecal Administration of Butorphanol, Sufentanil, and Nalbuphine in Sheep

Cited by 97 publications

References 0 publications

Efficiency of nalbuphine as an adjuvant to bupivancaine in lower limb orthopaedic surgery-a prospective study

Efficiency of nalbuphine as an adjuvant to bupivancaine in lower limb orthopaedic surgery-a prospective study

Side effects of intrathecal and epidural opioids

A Comparative Study of Epidural Nalbuphine With Bupivacaine vs. Bupivacaine Alone in Infraumbilical Surgeries

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