Analgesic Effect of Intrathecal Nalbuphine in Comparison with Fentanyl as an Adjuvant with Hyperbaric Bupivacaine (0.5%) during Spinal Anaesthesia in Lower Abdominal Surgery: A Double-blinded Randomised Clinical Study
Dr. Arunava Biswas,
Maharaja Jitendra Narayan Medical College and Hospital, Coochbehar, Coochbehar, West Bengal-736101, India.
Introduction: Local anaesthetics are sometimes added with intrathecal adjuvants. Nalbuphine is a synthetic agonistantagonist of opioid μ receptor. Fentanyl is a highly potent lipophilic synthetic opioid with rapid onset of action and it acts like morphine. It can be used during spinal anaesthesia for the purpose of decreasing the postoperative pain.
Aim: To compare the safety and efficacy of preservative free intrathecal nalbuphine and fentanyl as additives to intrathecal hyperbaric bupivacaine (0.5%) for spinal anaesthesia.
Materials and Methods: A randomised double-blinded clinical study was undertaken at Calcutta National Medical College and Hospital, Kolkata, West Bengal, India during March 2020 to August 2021 in which a total of 100 patients, belonging to American Society of Anaesthesiology (ASA) physical status I and II and undergoing elective lower abdominal surgery, were randomised into two equal group of 50 each. Group N received intrathecally 0.5 mg of nalbuphine with 3 mL (15 mg) of 0.5% hyperbaric bupivacaine, and group F received 25 μg of Fentanyl with 3 mL (15 mg) of 0.5% hyperbaric. Visual Analogue Scale (VAS) score, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Heart Rate (HR) were recorded at varied intervals during intraoperative and postoperative period.
Results: Significantly lower (p-value <0.001) mean VAS scores was observed beyond six hour of postoperative period in the group F. No significant changes (p-value >0.05) in SBP, DBP, MAP and HR were there between the groups. Few adverse effects like (hypotension, nausea, vomiting) were observed more in the fentanyl group which was statistically insignificant (p-value >0.05).
Conclusion: Intrathecal fentanyl as compared to nalbuphine produces a significant postoperative analgesia when administered as an adjuvant with hyperbaric bupivacaine in cases of lower abdominal surgery.