Intrathecal nalbuphine versus ketamine with hyperbaric bupivacaine in lower abdominal surgeries

Abstract

Background:Spinal anesthesia is an effective method of anesthesia with fewer side effects. The main limitations include the shorter duration of action and shorter postoperative analgesia when performed only with local anesthetics.Aim:The aim of this study is to compare adjuvants nalbuphine and ketamine to hyperbaric bupivacaine in spinal anesthesia with respect to the duration of analgesia, sensory and motor onset, hemodynamic status, and side effects.Settings and Design:This was a prospective, randomized, double-blind study.Materials and Methods:After ethical committee's clearance and informed consent, 90 patients of the American Society of Anesthesiologists physical status I and II were randomly allocated in three groups N, K, and B who received 3 ml hyperbaric bupivacaine with 0.8 mg nalbuphine, 3 ml hyperbaric bupivacaine with 25 mg ketamine (preservative free), and 3 ml hyperbaric bupivacaine with 0.5 ml normal saline, respectively.Statistical Analysis:Data were analyzed using paired t-test. Results were analyzed and compared to previous studies. SPSS-22 version of software was used, released 2013, IBM Corp., Armonk, NY, USA.Results:Mean duration of analgesia in Group N, K, and B was 290 ± 6.09, 220 ± 5.03, and 154 ± 6.04 min, respectively. Mean time of sensory onset in Group N, K, and B was 2.08 ± 0.34, 3.5 ± 0.25, and 4.5 ± 0.37 min, respectively. Time of motor onset was 7.60 ± 0.58, 7.79 ± 0.37, and 7.82 ± 0.53 min in Group N, K, and B, respectively.Conclusion:Nalbuphine is an effective adjuvant in spinal anesthesia with respect to sensory onset, duration of analgesia, and hemodynamic stability.

Analgesic Efficacy And Side Effects Of Three Different Doses Of Intrathecal Ketamine As An Adjuvant To Intrathecal Bupivacaine In Patients Undergoing Knee Arthroscopy: A Randomized Study

“…This suggests that all three doses of ketamine had comparable effects on maintaining hemodynamics throughout the perioperative period. Previous research investigating intrathecal ketamine administration at doses of 0.1 mg/kg and higher has consistently emphasized the cardiovascular stability associated with intrathecal ketamine (7,11,12). This mostly results from systemic absorption of ketamine and resultant cardiovascular stimulation.…”

“…Although higher doses of ketamine, specifically at or above 0.75 mg/kg, were associated with a notable occurrence of side effects like nystagmus, psychological disturbances, and pronounced hallucinations, the effectiveness of ketamine at lower doses (0.05 mg/kg, 0.1 mg/kg, 25 mg) as part of a multimodal treatment approach has been examined independently in various trials with no adverse events recorded (5)(6)(7). The objective of this study was to compare the postoperative analgesic effects of three different doses of intrathecal ketamine, administered in conjunction with bupivacaine, and explore the associated side effects for each dose to determine the dosage that exhibited superior postoperative analgesic effectiveness while causing minimal adverse effects.…”