COMPARISON OF NALBUPHINE VS DEXAMETHASONE WITH LEVOBUPIVACAINE IN ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK FOR PCNL SURGERIES: A COMPARATIVE OBSERVATIONAL STUDY
Main Article Content
Keywords
Dexamethasone, Levobupivacaine, Nalbuphine, Percutaneous nephrolithotomy (PCNL), , Erector spinae plane block (ESPB)
Abstract
Background: The erector spinae plane (ESP) block is a safe, simple interfascial plane block that provides good analgesia after thoracolumbar surgeries. Percutaneous nephrolithotomy (PCNL) is a minimally pervasive surgery used for renal stones. Opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and other regional analgesia techniques have been described previously in managing postoperative pain, but there is still controversy in finding an ideal method. Hence, the current study was undertaken to investigate.
Objective: This study was done to compare the efficacy of adding 10 mg Nalbuphine or 8mg Dexamethasone to 20 ml of 0.25% levobupivacaine in patients receiving ESP block scheduled for percutaneous nephrolithotomy surgery.
Methods: 100 cases of the American society of anesthesiologists grade I & II patients who were posted for percutaneous nephrolithotomy were enrolled and divided into two groups of 50 each.Group(N) received 20 ml of 0.25%Levobupivacine with 10 mg Nalbuphine. Group (D) received 20 mlof 0.25%levobupivacaine with 8 mg dexamethasone., The visual analogue scale score at 30 mins, 2nd ,4th,6th,8th,12th,16th,24hrs and the time required for 1st rescue analgesia and consumption of opioid in 24 hrs after surgery for both groups were measured.
Results: The visual analogue scale score at 8th,12th 16th, and 24 hrs. in group N were significantly lower than GROUP D (p< 0.05). The time for first rescue analgesia was longer in group N (784.33 ± 11.47mins) compared to group D (384.77 ± 13.55mins) (P< 0.001). Total opioid consumption was lower in Group N (82.73 ± 12.49) compared to Group D (254.97 ± 13.11) (P < 0.001)
Conclusion: Nalbuphine is more effective than dexamethasone in prolonging the duration of analgesia, delaying the time of first rescue analgesia, and reducing total opioid consumption when added to local anaesthetics inerector spinae block.
References
2. Schlondorff D. Renal complications of nonsteroidalantiinflammatory drugs. Kidney Int. 1993;44:643–53.
3. Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, et al. Opioid complications and side effects. PainPhysician. 2008;11:105–20.
4. Baidya DK, Khanna P, Maitra S. Analgesic efficacy and safety of thoracic paravertebral and epidural analgesia for thoracic surgery:A systematic review and meta-analysis. Interact CardioVascThorac Surg. 2014;18:626–35.
5. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block:A Novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41:621–7.
6. De la Cuadra-Fontaine JC, Concha M, Vuletin F, et al. Continuous Erector Spinae Plane block for thoracic surgery in a pediatric patient. Paediatr Anaesth 2018;28:74-75. 10.1111/pan.13277.
7. Paladini G, Musella G, Farris G, et al. Erector spinae plane block to enhance recovery after thoracoscopic lung lobectomy in infants. Minerva Anestesiol 2019. [Epub ahead of print]. 10.23736/S0375-9393.19.13880-1.
8. Jain K, Jaiswal V, Puri A. Erector spinae plane block:Relatively new block on horizon with a wide spectrum of application - A case series. Indian J Anaesth. 2018;62:809–13.
9. Schmidt W, Tam S, Shotzberger G, Smith D, Clark R, Vernier V. Nalbuphine. Drug and Alcohol Dependence. 1985;14(3-4):339-362.
10. Narver H. Nalbuphine, a non-controlled opioid analgesic, and its potential use in research mice. Lab Animal. 2015;44(3):106-110.
11. Peng X, Knapp B, Bidlack J, Neumeyer J. Pharmacological Properties of Bivalent Ligands Containing Butorphan Linked to Nalbuphine, Naltrexone, and Naloxone at μ, δ, and κ Opioid Receptors. Journal of Medicinal Chemistry. 2007;50(9):2254-2258
12. Rao J, Gao Z, Qiu G, Gao P, Wang Q, Zhong W, Wang Y, Li Y. Nalbuphine and dexmedetomidine as adjuvants to ropivacaine in ultrasound-guided erector spinae plane block for video-assisted thoracoscopic lobectomy surgery: A randomized, double-blind, placebo-controlled trial. Medicine (Baltimore). 2021 Aug 13;100(32):e26962. doi: 10.1097/ MD. 000 0 000000026962. PMID: 34397949; PMCID: PMC8360433.
13. Ahmed HI, Ali AR, El Emam NH, Magdy M, Gamal RM. Dexmedetomidine vs dexamethasone as adjuvants to levobupivacaine in ultrasound-guided erector spinae plane block for patients undergoing modified radical mastectomy: a randomized double-blind study. Anaesth. pain intensive care 2022;27(1):65−72.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr. Swathi Gundlakunta
Assistant Professor, Department of Anaesthesiology, Narayana Medical College, Nellore, Andhra Pradesh, India
Dr. G. Chaitanya Kumar
Associate Professor, Department of Anaesthesiology, Narayana Medical College, Nellore, Andhra Pradesh, India
Dr. R. Prabavathi
Professor, Department of Anaesthesiology, Narayana Medical College, Nellore, Andhra Pradesh, India
Dr. Dhanasri. Y
Post Graduate, Department of Anaesthesiology, Narayana Medical College, Nellore, Andhra Pradesh, India
Dr. Avula Charan Teja Reddy
Senior Resident, Department of Anaesthesiology, Narayana Medical College, Nellore, Andhra Pradesh, India
Dr. Rupa Reddy
Senior Resident, Department of Anaesthesiology, Narayana Medical College, Nellore, Andhra Pradesh, India