Postoperative Analgesic Efficacy of Intrathecal Tramadol Versus Nalbuphine Added to Bupivacaine in Spinal Anaesthesia for Lower Limb Orthopaedic Surgery

Verma, Devendra; Naithani, Udita; Jain, D. C.; Singh, Ajay

doi:10.14260/jemds/1118

Cited by 21 publications

(28 citation statements)

References 15 publications

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“…(8) In our study nalbuphine added as adjuvant to ropivacaine is found to be more potent and efficacious. In a similar study by Verma (25) in 2013 proved that nalbuphine when added to bupivacaine intrathecally improves postoperative analgesia, which is consistent with our result. In table 4, results did not show any statistically significant difference for mean heart rate at pre-operatively (p=0.146) and at baseline (p=0.677).…”

Section: Equipotency Of Dose Of Epidural Ropivacainesupporting

confidence: 91%

Postsurgical Analgesic Efficacy of Epidural Nalbuphine in Lower Abdominal Surgeries

Dalal¹,

Ninave²

2020

jemds

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BACKGROUND Epidural analgesia has been the gold standard, preferred technique for providing postoperative analgesia in lower abdominal, lower limb, pelvic and vascular surgeries. Combination of local anaesthetic agents when used along with opioids, as an adjuvant in epidural analgesia, was found to be effective and synergistic. Ropivacaine is associated with less central nervous system toxicity and cardiotoxicity, and produces less motor blockade. Nalbuphine is an opioid with mixed kappa (κ) agonist and mu (µ) antagonistic properties, when mixed with other opioids, attenuates the µ opioid effect and enhances the κ opioid effect. We wanted to compare the post-surgical analgesic efficacy of epidural nalbuphine (10 mg) when added as an adjuvant to epidural ropivacaine (0.2%-9 ml) in patients undergoing lower abdominal surgeries. Primary objective was to compare the duration of postoperative analgesia and number of rescue analgesics required in 24 hours. Secondary objectives were to compare postoperative haemodynamic variation, quality of analgesia, Visual Analogue Score and side effects if any in both the groups. METHODS It was prospective observational study conducted after obtaining ethical committee clearance. Sixty patients of ASA class I & II, fulfilling inclusion criteria posted for elective lower abdominal surgeries preferably abdominal hysterectomies divided into two groups, each comprising of 30 patients; group R-Ropivacaine-0.2%-9 ml with 1 ml normal saline and group R+N-0.2%-9 ml with nalbuphine 1 ml-10 mg, under spinal anaesthesia with epidural catheter insertion. Parameters like duration of analgesia, number of rescue analgesia, quality of analgesia by patient rated quality of pain management, haemodynamic variation was assessed. Assessment of pain was done by VAS scale, side effects like sedation was assessed by modified Ramsay sedation scale. RESULTS No demographic variation was found in any group. Mean duration of analgesia was found more in group R+N. Number of rescue analgesia was reduced in group R+N with improved quality of analgesia which was statistically significant. Mean HR was significant in group R+N. No change was noted in SBP, RR, SpO2 in either group. DBP and MAP showed statistically significant difference at 30, 60 min and 15, 30, 60 min respectively. None of the patients in either group had sedation; one episode of vomiting was noted in group R+N with statistically non-significant results. CONCLUSIONS Epidural Nalbuphine-10 mg when added as adjuvant with 0.2% Ropivacaine-9 ml improves duration and quality of analgesia with reduction in rescue analgesia and side effects with haemodynamic stability.

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Section: Equipotency Of Dose Of Epidural Ropivacainesupporting

confidence: 91%

Postsurgical Analgesic Efficacy of Epidural Nalbuphine in Lower Abdominal Surgeries

Dalal¹,

Ninave²

2020

jemds

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“…Verma et al . [ 16 ] showed that postoperative analgesia was significantly improved by the addition of nalbuphine. Mostafa et al .…”

Section: Discussionmentioning

confidence: 99%

Epidural nalbuphine for postoperative analgesia in orthopedic surgery

et al. 2015

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Background:The challenging task of postoperative pain relief comes within the realm of the anesthesiologist. Combined spinal epidural (CSE) anesthesia can be used as the sole technique for carrying out surgical procedures and managing postoperative pain using various drug regimes. Epidural administration of opioids in combination with local anesthetic agents in low dose offers new dimensions in the management of postoperative pain.Aims:Comparative evaluation of bupivacaine hydrochloride with nalbuphine versus bupivacaine with tramadol for postoperative analgesia in lower limb orthopedic surgeries under CSE anesthesia to know the quality of analgesia, incidence of side effects, surgical outcome and level of patient satisfaction.Settings and Design:A prospective, randomized and double-blind study was conducted involving 80 patients of American Society of Anesthesiologists physical status I and II coming for elective lower limb orthopedic surgeries carried under spinal anesthesia.Materials and Methods:Anesthesia was given with 0.5% of 2.5 ml bupivacaine intrathecally in both the groups. Epidurally 0.25% bupivacaine along with 10 mg nalbuphine (group A) or tramadol 100 mg (group B) diluted to 2 ml to make a total volume of 10 ml was administered at sensory regression to T10.Statistical Analysis:The data were collected, compiled and statistically analyzed with the help of MS Excel, EPI Info 6 and SPSS to draw the relative conclusions.Results and Conclusions:The mean duration of analgesia in group A was 380 ± 11.49 min and in group B was 380 ± 9.8 min. The mean sedation score was found to be more in group B than group A. The mean patient satisfaction score in group A was 4.40 ± 0.871 and in group B was 3.90 ± 1.150 which was found to be statistically significant (P < 0.05). We concluded that the addition of nalbuphine with bupivacaine was effective for postoperative analgesia in terms of quality of analgesia and patient satisfaction score as compared to tramadol.

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“…Recently, the analgesic effects of morphine and nalbuphine, a synthetic opiate with mixed agonist-antagonist actions, have been reported [56]. As a novel opioid κ receptor agonist-antagonist, nalbuphine, can agitate the κ receptors to achieve a superior analgesic effect and antagonize the μ receptors to reduce the incidence of adverse reactions [78].…”

Section: Introductionmentioning

confidence: 99%

Sedative, analgesic, behavioral and clinical effects of intravenous nalbuphine-xylazine combination in camels (Camelus dromedarius)

Khalil

Algalil²,

Sabek

et al. 2019

J Vet Sci

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This study examined the sedative, analgesic, behavioral, and clinical effects of a combination of xylazine (XY) and nalbuphine-xylazine (NA-XY) in camels. A total of five adult camels were used in a prospective randomized cross-over design with a wash out period of two weeks. Camels were allocated randomly to two treatment groups: the XY group (xylazine, 1.1mL/100 kg IV) and the NA-XY group (xylazine, 1.1mL/100 kg IV and nalbuphine, 1 mg/kg IV). The sedative, analgesic, behavioral, and clinical effects of XY and NA-XY combination were evaluated prior to administration (baseline) and at 5, 15, 30, 45, 60, 75, 90, and 120 minutes post-administration. The results showed that the NA-XY combination accelerates the onset of sedation and analgesia and prolongs the durations of both sedation (p < 0.001) and analgesia (p < 0.01). The behavioral parameters showed higher scores with a NA-XY combination than xylazine alone. Although a XY injection resulted in a significant decline in the heart and respiratory rate, the NA-XY combination group revealed a non-significant change in both clinical parameters compared to the baseline. In conclusion, the use of a NA-XY combination in camels improved the sedative and analgesic onset and duration with an improved outcome in the behavioral scores, as well as in both the heart and respiratory rates compared to XY alone.

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Postoperative Analgesic Efficacy of Intrathecal Tramadol Versus Nalbuphine Added to Bupivacaine in Spinal Anaesthesia for Lower Limb Orthopaedic Surgery

Cited by 21 publications

References 15 publications

Postsurgical Analgesic Efficacy of Epidural Nalbuphine in Lower Abdominal Surgeries

Postsurgical Analgesic Efficacy of Epidural Nalbuphine in Lower Abdominal Surgeries

Epidural nalbuphine for postoperative analgesia in orthopedic surgery

Sedative, analgesic, behavioral and clinical effects of intravenous nalbuphine-xylazine combination in camels (Camelus dromedarius)

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