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Comparison of Nalbuphine Versus Buprenorphine as an Adjuvant to Intrathecal Bupivacaine for Postoperative Analgesia in Lower Abdominal and Lower Limb Surgeries

Manchireddy Manish, Post graduate, Department of Anaesthesiology, Sri Sri Venkateshwaraa medical college and hospital. Ariyur, Puducherry 605102, India. , R. Krishna Prabu1 , Manchireddy Manish2

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Indian Journal of Anesthesia and Analgesia 5(6):p 998-1003, June 2018. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5618.19

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Abstract

Introduction: Opioids when added to local anaesthetics in sub-arachnoid block decreases the dose of local anaesthetics and offers stable hemodynamics. Nalbuphine is an agonist-antagonist act on kappa receptors providing analgesia. Buprenorphine is a mixed agonist-antagonist narcotic with high affinity at both m and kappa opiate receptors.

 Aim: In this study we have compared the analgesic efficacy of buprenorphine and nalbuphine when added with bupivacaine in spinal anaesthesia.

Material and Methods: A randomized, double blinded, prospective study on 60 patients of ASA I and II undergoing lower abdomen and lower limb surgery under subarachnoid block was done. Patients were randomly allocated into two groups (n=30). Each group received 15 mg of 0.5% of injection bupivacaine heavy along with either 60ìg of buprenorphine (Group B) or 0.8 mg nalbuphine (Group N). Characteristics of sensory and motor blocks, haemodynamic changes, duration and quality of analgesia, adverse effects, sedation, visual analog score (VAS) score and analgesic requirement were studied at different time intervals.

Results: Onset of sensory block for Group N is 1.519±0.367 and Group B is 2.665±0.462. Onset of motor block for Group N is 4.639±0.976 and Group B is 3.686±0.373. Duration of sensory block in Group N is 170.60±24.42 and Group B is 237.93±16.43. Duration of motor block in Group N is 257.17±27.74 and Group B is 410.93±17.79. The duration of analgesia (in minute) was 295.60±18.95 in N Group and 566.43±42.19 in Group B. There was no significant difference regarding block characteristics and haemodynamic parameters. The adverse effects were less in N Group.

Conclusion: Onset of sensory and motor block was faster in Group N compared to Group B. The VAS scores showed that post operative analgesia lasted significantly longer in patients in group B than in group N. No significant side effects were observed in either of the two groups. Sub-arachnoid buprenorphine provides longer duration of post-operative analgesia compared to nalbuphine.

 

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.5618.19

Keywords

Buprenorphine; Intrathecal; Local Anaesthetics; Nalbuphine; Opioids.

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