“A COMPARATIVE STUDY TO ASSESS THE EFFICACY OF INTRATHECAL NALBUPHINE 1MG VERSUS INTRATHECAL FENTANYL 25MCG AS AN ADJUVANT TO 0.5% HYPERBARIC BUPIVACAINE FOR LOWER ABDOMINAL SURGERIES

Abstract

Background: Subarachnoid block/spinal anaesthesia is the most commonly used method for lower abdominal and lower leg procedures 1 . It offers various advantages over general anesthesia, such being less expensive, having a speedier onset of anaesthesia with less intraoperative blood loss, and providing good postoperative analgesia

2.AIM: To evaluate the effect of intrathecal hyperbaric bupivacaine 0.5% 3ml plus nalbuphine 1mg compared to hyperbaric bupivacaine 0.5% 3ml plus fentanyl 25 mcg in lower abdominal surgical procedures regarding,
OBJECTIVES: • Onset and the duration of sensory block • Onset and the duration of motor block • Hemodynamic changes • Side effects • Time to rescue analgesia
MATERIAL & METHODS: Study Design: Prospective, randomized open-label study. Study area: The study was conducted in the Department of Anaesthesia, Akash Institute of Medical Science & Research Centre, Bengaluru from January 2023 to October 2023. Study Period: 1 year. Study population: The study group comprised of patients admitted to hospital for lower abdominal surgeries. Sample size: Study consisted a total of 80 subjects. Sampling Technique: Simple Random technique. Study tools and Data collection  procedure: Eighty patients aged between 20 years and 60 years of physical status ASA grade 1 and ASA grade 2 scheduled for lower abdominal operations will be included in the study after receiving approval from the institutional ethical committee. A detailed preoperative evaluation will be done for all the patients. All routine investigations required will be done. The procedure will be explained and written informed consent will be obtained. Patients will be pre-medicated with tablet Alprazolam 0.5 mg overnight. Patients will be allowed for a period of absolute fasting of 8 hours. On arrival in the operating room, monitors –ECG, NIBP, SPO2 will be connected and baseline readings will be recorded. An intravenous line will be secured with an 18G Intravenous cannula and Ringer’s lactate will be started. Patients were randomized to 2 groups of 40 each based on a sealed envelope technique for the intrathecal injection: 1. Group N (n=40) - 15mg of 0.5 percent hyperbaric bupivacaine and nalbuphine 1mg plus 0.4 ml NS. Total volume 3.5ml, 2. Group F (n=40) - 15mg of 0.5 percent hyperbaric bupivacaine and Fentanyl 25mcg (0.5ml). Total volume 3.5ml Results: In this study, mean ±SD time to rescue analgesia (hours) in the nalbuphine group was 5.94±0.34 hours, and the mean ± SD time to rescue analgesia (hours) in the fentanyl group was 4.14±0.32 hours. The mean difference between nalbuphine and fentanyl groups for time to rescue analgesia (hours) was shown statistically significant (P<0.0001).
CONCLUSION: In this study, we found that nalbuphine plus bupivacaine significantly prolonged analgesia duration compared to fentanyl plus bupivacaine in lower abdominal surgeries.