A Comparison between Post-Operative Analgesia after Intrathecal Injection of Nalbuphine versus Fentanyl as an Adjuvent to Bupivacaine after Cesarean Section

Ibrahim, A Y; Kamal, Kareem Youssef; Fahim, Hany Magdy; Ahmed, Ahmed Nasser

doi:10.21608/ejhm.2018.11383

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…13,14 Other studies favored the use of intrathecal nalbuphine as it provided better postoperative analgesia and lower + adverse events than fentanyl or midazolam. [15][16][17] Further studies informed better outcomes achieved by intrathecal midazolam over nalbuphine. 18,19 On the contrary, Sawhney et al, who studied the impact of combining fentanyl or midazolam with LA in lower limb operations versus bupivacaine alone, stated that adding adjuvants did not significantly extend the length of the block.…”

Section: Discussionmentioning

confidence: 99%

Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective Cesarean Section; a randomized controlled double-blind trial

Amin

Souidan

Abdelzaam

2023

Anaesth. pain intensive care

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Background: Different adjuvants have been introduced to enhance the quality of local anesthetics and reduce its adverse events. This study was directed to compare the anesthetic and analgesic properties of intrathecal hyperbaric bupivacaine when three different adjuvant drugs were added. Methodology: One hundred full-term parturients aged 18 to 40 years, scheduled for elective cesarean section, were randomly assigned to 4 groups. Each group received 12.5 mg of 0.5% hyperbaric bupivacaine combined with either 0.5 ml saline (Group-B), 25µg fentanyl (Group-F), 0.8 mg nalbuphine (Group-N) or 2 mg midazolam (Group-M). The outcomes included the postoperative effective analgesia time, the sensorimotor characteristics, postoperative VAS score, pethidine consumption, maternal complications, and neonatal Apgar score. Results: Earlier onset of sensory and motor block was observed in Group F and N than in Group B and M. Duration of postoperative effective analgesia was longer in Groups F, N and M (252.42 ± 46.11, 227.34 ± 36.54 and 243.71 ± 44.95 hours, respectively) than in Group B (172.11 ± 20.99) (P < 0.001). VAS scores decreased in adjuvant groups during the first 12 hours postoperative and required pethidine doses were less. Conclusion: Addition of adjuvant agents to intrathecal bupivacaine improved the quality of subarachnoid block without increasing side-effects. Intrathecal midazolam provided comparable outcomes as the frequently used opioids. Abbreviations: CS: Cesarean section; LA: Local anesthetics; SA: Spinal anesthesia Key words: Intrathecal; Nalbuphine; Midazolam; Fentanyl; Postoperative analgesia; Cesarean section. Citation: Amin SR, Souidan I, Abdelzaam EM. Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective cesarean section: a randomized controlled double-blind trial. Anaesth. pain intensive care 2022;27(1):89−96; DOI: 10.35975/apic.v27i1.1923 Received: June 26, 2022; Reviewed: November 28, 2022; Accepted: December 14, 2022

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Section: Discussionmentioning

confidence: 99%

Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective Cesarean Section; a randomized controlled double-blind trial

Amin

Souidan

Abdelzaam

2023

Anaesth. pain intensive care

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A Comparison between Intrathecal Nalbuphine versus Fentanyl as an Adjuvant with 0.5% Hyperbaric Bupivacaine for Postoperative Analgesia in Parturients Undergoing Lower Segment Cesarean Section

Sethi

Jain²,

Saini³

et al. 2022

Journal of Obstetric Anaesthesia and Critical Care

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Background: Nalbuphine when used as an adjuvant to hyperbaric bupivacaine has improved the quality of perioperative analgesia. Fentanyl is a lipophilic opioid with a rapid onset and does not cause respiratory depression and improves duration of sensory anesthesia without producing significant side effects. The aim of this study was to compare intrathecal nalbuphine and fentanyl as adjuvants to hyperbaric bupivacaine for postoperative analgesia in lower segment cesarean section. Methods: A total of 100 American Society of Anesthesiologists (ASA) Physical Status (PS) I and II parturients were enrolled for lower segment cesarean section. Parturients were randomly allocated into 2 groups - Group F (n = 50) received bupivacaine 0.5% (heavy) 1.6 ml (8 mg) + fentanyl 20 μg (0.4 ml) and Group N (n = 50) received bupivacaine 0.5% (heavy) 1.6 ml (8 mg) + nalbuphine 0.4 mg (0.4 ml) under subarachnoid block (total volume = 2 ml). Time of onset and duration of sensory and motor block, Visual Analog Scale (VAS) score, duration of analgesia, sedation, rescue analgesic consumption, APGAR score, hemodynamic changes and adverse effects were noted. Results: Onset of sensory and motor block were significantly faster in Group F while duration of sensory block was significantly longer in Group N (P < 0.05). Duration of analgesia was also significantly longer in Group N (214.34 ± 9.31 min) compared to Group F (195.00 ± 9.18 min) (P < 0.001). No significant hemodynamic changes and adverse effects were noted in both groups (P > 0.05). Conclusion: Both of these drugs can be effectively used as an adjuvant to hyperbaric 0.5% bupivacaine in subarachnoid block for parturients undergoing lower segment cesarean section.

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A Comparison between Post-Operative Analgesia after Intrathecal Injection of Nalbuphine versus Fentanyl as an Adjuvent to Bupivacaine after Cesarean Section

Cited by 2 publications

References 4 publications

Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective Cesarean Section; a randomized controlled double-blind trial

Intrathecal midazolam is a comparable alternative to fentanyl and nalbuphine as adjuvant to bupivacaine in spinal anesthesia for elective Cesarean Section; a randomized controlled double-blind trial

A Comparison between Intrathecal Nalbuphine versus Fentanyl as an Adjuvant with 0.5% Hyperbaric Bupivacaine for Postoperative Analgesia in Parturients Undergoing Lower Segment Cesarean Section

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