INTRATHECAL NALBUPHINE: AN EFFECTIVE ADJUVANT FOR POST OPERATIVE ANALGESIA

Abstract

Various adjuvants have been used along with local anaesthetics for prolongation of analgesia post operatively in neuraxial blockade. The frequently used adjuvants are opioids, midazolam, neostigmine, ketamine etc. Neuraxial opioids bind to intrathecal opioid receptors and produce effective pain relief post operatively with minimal untoward effects. However, certain adverse effects like pruritis, post operative nausea and vomiting, urinary retention and respiratory depression have been observed with the use of majority of opioids. Nalbuphine is an opioid drug with mixed μ antagonist and κ agonist properties. Thus we conducted a prospective, randomized study to observe the effect of intrathecal nalbuphine on pain relief after lower limb and lower abdominal surgeries. Sixty patients of ASA grades I and II of either sex in the age group of 18-65 years were randomly allocated to one of the two groups. Group B (n = 30) received 0.5% hyperbaric bupivacaine intrathecally; group N (n = 30) received 0.5% hyperbaric bupivacaine + 0.8 mg nalbuphine (preservative free) intrathecally. The onset of sensory and motor blockade, highest level of sensory blockade, duration of motor blockade and analgesia, VAS score, hemodynamic and respiratory changes, side effects were recorded, tabulated, and analyzed. Onset of sensory and motor blockade was faster in group N. The VAS scores showed that post operative analgesia lasted significantly in patients in group N than in group B. No significant side effects were observed in either of the two groups. Thus we conclude that intrathecal nalbuphine improved the quality of intraoperative and postoperative analgesia, with minimal side effects.