Abstract

This study aimed to compare intrathecal nalbuphine and dexmeditomidine as an adjuvant in spinal anesthesia for lower limb and lower abdominal surgeries to improve the quality of spinal anesthesia (onset, duration, and side effects) and prolongation of duration of postoperative analgesia Hyperbaric bupivacaine, a local anesthetic, has a short half-life of 2 to 2 ½ hours. Hence several adjuvants have been tested to enhance and prolong its analgesic effect. Initially, the preemptive combination of intrathecal opioids like fentanyl, nalbuphine, buprenorphine were extensively studied and found to have its own side effects and of late alpha -2 agonist like dexmeditiomidine with this local anesthetic for regional anesthesia, is being studied. Aim: In the present study we tried to compare intrathecal nalbuphine and dexmedetomidine as adjuvants in spinal anaesthesia for lower limb and lower abdominal surgeries. Methods: The present study was conducted in the department of anaesthesiology, KIMS,Narketpally during Oct 2021 to Sep 2022. This study was a prospective, randomised controlled, single blind, study conducted in 60 patients of ASA grade I and II undergoing elective surgeries under spinal anaesthesia. The patients were divided randomly with computer randamizer software into two groups, containing 30 patients in each group. Drugs selected are divided as Group BN: Patients received 3 ml of 0.5% hyperbaric bupivacaine (15mg) plus 1mg nalbuphine and Group BD: Patients received 3 ml of 0.5% hyperbaric bupivacaine (15mg) plus 5 µg Dexmedetomidine. Spinal block characteristics, blood pressure, pulse rate and side effects were studied during intra-operative and postoperative period. Results: It was observed from present study that in Dexmedetomidine group onset and complete motor blockade was early and duration of anaesthesia and analgesia was significantly prolonged compared to the Nalbuphine group. Hemodynamic parameters were preserved both intra-operatively and postoperatively in both groups. However there were a small percentage of patients who developed hypotension and bradycardia with dexmedetomidine which were easily managed without any untoward effect. Conclusions: Intrathecal low dose Dexmedetomidine in a dose of 5µg along with 0.5% hyperbaric bupivacaine is associated with prolonged onset, duration, and side effects sensory and motor blockade compared to 1mg of nalbuphine for spinal anaesthesia in patients undergoing elective lower abdominal and lower limb surgeries.

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