Comparative study between intrathecal Nalbuphine and Fentanyl as an adjuvant to hyperbaric Bupivacaine in transabdominal hysterectomy

Abstract

Background: The study was to compare the sensory and motor blockade characteristics and duration of postoperative analgesia between Nalbuphine and Fentanyl as an adjunct to intrathecal Bupivacaine in spinal anaesthesia. Settings and design: To compare the clinical efficacy of hyperbaric Bupivacaine with Fentanyl and hyperbaric Bupivacaine with Nalbuphine with reference to onset and duration of sensory block, onset and duration of motor block, duration of post op analgesia, hemodynamic stability, level of sedation and complications. Methodology: 60 female patients of 30-55 years of age with ASA Ι, II undergoing elective trans-abdominal hysterectomy under spinal anaesthesia were randomly allocated to two groups. Group BUF -0.5ml (25µg) Fentanyl and Group BUN -0.5 ml (1 mg) Nalbuphine, with 3ml of 0.5% hyperbaric Bupivacaine. Onset and duration of sensory block, duration of post op analgesia, hemodynamic stability, level of sedation and complications were assessed. Statistical analysis: Data were analysed using Student t test and Chi-square test for parameters on continuous scale and categorical scale respectively p value < 0.05 was considered significant. Results: Though onset of sensory and motor block was faster in BUF, the BUN group had prolonged post op analgesia. Mean VAPS reduction at 24hr in BUN (3.26+/-0.541) compared to BUF (2.78+/-0.585) was statistically significant with p value 0.0016(<0.05). No statistical significance was seen with respect to hemodynamic stability and duration of motor block. Conclusion: Nalbuphine, an agonist-antagonist is a good adjuvant to intrathecal Bupivacaine, providing intense and prolonged postoperative analgesia without any significant adverse effects.