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ORIGINAL ARTICLE
Year : 2018  |  Volume : 35  |  Issue : 3  |  Page : 297-306

Intrathecal nalbuphine as an adjuvant to bupivacaine in spinal anesthesia for lower-limb surgeries: intraoperative and postoperative effects


1 Department of Anesthesiology and Intensive Care, Faculty of Medicine, Benha University, Benha, Egypt
2 Department of Anesthesiology and Intensive Care, Faculty of Medicine, Benha University, Benha; Department of Anesthesia, Ministry of Health, Benha City, Egypt

Correspondence Address:
Dr. Walid H.I Moftah
Department of Anesthesia, Faculty of Medicine, Benha University, Benha, 44511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bmfj.bmfj_81_17

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Background Many opioids are added to intrathecal local anesthetics to provide longer duration of analgesia; however, we have to choose an additive with the longest analgesic time and least intraoperative and postoperative side effects. In this study, nalbuphine was compared with fentanyl and pethidine as additives to hyperbaric bupivacaine used in spinal anesthesia for lower-limb surgeries. Patients and methods A total of 100 patients of both sexes, American Society of Anesthesiologists I and American Society of Anesthesiologists II, scheduled for lower-limb surgeries under spinal anesthesia were assigned randomly into four groups: group B received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml sterile water; n=25); group N received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml nalbuphine 500 μg; n=25); group F received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml fentanyl 25 μg; n=25); and group P received intrathecal injection of 0.5% hyperbaric bupivacaine (3+1 ml pethidine 10mg; n=25). We recorded the onset of sensory and motor blocks, peak sensory and motor block times, sensory block levels and two-segment regression time using the pin-prick method, motor block level using the modified Bromage scale, and any intraoperative or postoperative complications. Results The mean onset of sensory block significantly decreased in groups N, F, and P compared with group B, whereas the peak sensory time did not significantly change in all the four groups. In contrast, the mean onset of the motor block in all four groups was nonsignificantly different, whereas the mean time for peak motor block was significantly short in both the N group (nalbuphine and bupivacaine) and the P (pethidine and bupivacaine) group compared with the B (bupivacaine alone) and F (fentanyl and bupivacaine) groups. There was significant prolongation in both two-segment regression time and the first analgesic request time in groups N, F, and P (all narcotics and bupivacaine) compared with group B (bupivacaine alone). Conclusion Nalbuphine, fentanyl, and pethidine as adjuvants to spinal anesthesia prolong the duration for first-rescue analgesia with minimal hemodynamic and respiratory complications; however, nalbuphine at a dose of 0.5 mg has the best quality of spinal block when added to intrathecal 0.5% heavy bupivacaine in patients undergoing lower-limb surgeries.


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