EFFECT OF ADDING NALBUPHINE VS FENTANYL ON BLOCK CHARACTERISTICS OF 0.75% HYPERBARIC ROPIVACAINE IN LOWER LIMB SURGERY: A RANDOMIZED CONTROL TRIAL

Abstract

Background: Fentanyl and Nalbuphine are the commonly used adjuvant drugs in spinal anesthesia. The efficacy of these drugs along with Hyperbaric Ropivacaine remains better but the question remains unsolved that whether Ropivacaine plus fentanyl or ropivacaine plus Nalbuphine, which works better. Hence this study was undertaken to compare the effects of fentanyl and nalbuphine as adjuvants to 0.75% hyperbaric ropivacaine of spinal blockade in terms of onset, duration, hemodynamic parameters, and adverse effects.

Methods: This prospective randomized, control study was conducted among patients undergoing lower limb surgeries in Rohilkhand Medical College Hospital, Bareilly for elective surgical procedures. Sixty-eight patients were included in the study with 34 patients for each group. Group A - 3ml of “Hyperbaric   Ropivacaine” with 25 ug Intrathecal Fentanyl and Group B - 3ml of “Hyperbaric Ropivacaine” with 0.8 mg Intrathecal Nalbuphine. Under all aseptic precautions, spinal anaesthesia was given with the study drug injected between L3-L4 or L4-L5 inter vertebral space, using a 25G (Quincke   needle) in the Sitting Position. Then the patient would be immediately taken into Lateral or Supine Position for surgery. The patient was evaluated for Motor and Sensory block, immediately after spinal anaesthesia for onset of action of drug and duration of action of the drug. During the surgery the patient’s pulse rate, Systolic and Diastolic blood pressure, Mean Arterial  Pressure was recorded every 3 mins for 30 minutes and  then every 5 minutes  until completion of the surgery. Data analysis was done using SPSS version 17.

Results: The time to onset of sensory block, the time to onset of Motor block and the duration of the motor blockade was significantly higher in Group A Fentanyl with Hyperbaric-ropivacaine compared to Group B Nalbuphine with Hyperbaric Ropivacaine group. Although our study showed non-significant results for the duration of the sensory blockade between both the groups. The first rescue analgesia was more in Group B Ropivacaine plus Nalbuphine Group as compared to Ropivacaine plus Fentanyl, reducing the analgesic requirement in the early post-operative period. The hemodynamic parameters were more stable in both the groups.

Conclusion: Fentanyl with hyperbaric ropivacaine provides better blockade time and duration but Nalbuphine shows better rescue analgesia with no difference between both the groups in terms of hemodynamic stability.