Comparison of duration of analgesic effect of nalbuphine and morphine as an adjuvant to bupivacaine in the supraclavicular block under ultrasound guidance

Abstract

Background: Although many studies are available in the literature that has analyzed the effects of morphine, nalbuphine, and other opioids, no study had compared the effects of nalbuphine versus morphine as an adjuvant to bupivacaine in the supraclavicular block under the guidance of ultrasound. Methodology: A randomized, double-blinded, prospective study was carried out on 60 patients of the American Society of Anesthesiologists Class I and II who were undergoing upper limb surgeries under the supraclavicular block. Patients were randomly allocated into two groups ( n = 30). Group N received 20 ml of 0.5% bupivacaine with 50 μg.kg −1 of nalbuphine, while Group M received 20 ml of 0.5% bupivacaine with 50 μg.kg −1 of morphine. The characteristics of sensory and motor blocks, hemodynamic changes, duration of analgesia, adverse effects, and analgesic requirements were studied at different time intervals. Results: In Group N, there was a statistically significant reduction in the time of onset of sensory block (9.9 ± 3.0 vs. 12.2 ± 2.6 min, P = 0.002) and motor block (14.4 ± 3.6 vs. 19.4 ± 3.6 min, P = 0.0005). The duration of sensory and motor blockade and duration of analgesia were comparable. There was no statistically significant difference regarding block characteristics and hemodynamic parameters. Conclusion: Nalbuphine when added to bupivacaine as an adjuvant had significantly shortened the time of onset of sensory and motor blockade than morphine. However, the duration of analgesia, sensory and motor blockade of nalbuphine versus morphine were comparable.

The effect of adjuvants added to local anaesthetics for single-injection upper extremity peripheral regional anaesthesia

“…In 161 studies, patients received a supraclavicular brachial plexus block, 26,29–160 in 40 studies, patients received an axillary brachial plexus block, 24,27,161–198 in 28 studies, an interscalene block was performed, 25,199–220 in 11 studies, patients received an infraclavicular brachial plexus block, 221–231 one study used a coracoid approach to brachial plexus block 232 and one study used a suprascapular combined with axillary nerve block 233 . A detailed description of included studies is presented in the supplemental content (supplemental table 3, http://links.lww.com/EJA/A839).…”

A prospective, randomized, double blinded comparative study between 0.5% bupivacaine and 0.5% bupivacaine with pentazocine as an adjuvant in supraclavicular brachial plexus block for post operative analgesia in upper limb surgery: Pentazocine as adjuvant in brachial plexus block

“…A study by Vengadessane et al 21 has observed a longer duration of block and postoperative analgesia with a lesser dose of the drug (nalbuphine 50 µg/kg with 20 ml of 0.5% bupivacaine). This may be attributable to the use of ultrasound in their study.…”

“…Opioids belonging to mixed agonist-antagonists like butorphanol and nalbuphine have also been used as adjuvants to local anesthetics in several studies with favorable results [18][19][20][21][22][23][24] . Pentazocine belongs to a mixed agonist-antagonist opioid-like nalbuphine and butorphanol 4,25 but no study to date has used pentazocine as an adjuvant to local anesthetic in brachial plexus block.…”

Effect of Multimodal Preemptive Analgesia of Flurbiprofen Axetil, Nalbuphine, and Retrobulbar Block on Postoperative Pain and Enhanced Recovery in Patients Undergoing Oculoplastic Day Surgery: A Prospective, Randomized, Double-Blinded Study

“…Nalbuphine, a new type of synthetic opioid, is frequently used to treat moderate pain, which exhibits analgesic effects similar to morphine. 31 It has a better safety profile with milder μ receptor-related adverse effects and lower dependence compared with other opioids, as it is primarily a κ agonist and a partial μ antagonist. 32,33 In the present study, our results showed that the pain scores over the 24 hours in the nalbuphine group did not differ from that of the control, except for the first 2 postoperative hours, which can be explained by a half-life of 2 to 5 hours after nalbuphine intravenous injection.…”