“Comparison of nalbuphine hydrochloride and fentanyl as an adjuvant to bupivacaine for spinal anesthesia in lower abdominal surgeries:” A randomized, double-blind study

Prabhakaraiah, Umesh N; Narayanappa, Archana B; Gurulingaswamy, Shivakumar; K, Krishna Chaithanya; Vijaynagar, Kiran A; Hanumantharayappa, Nagarajaiah B; Ramegowda, Diwakar S

doi:10.4103/aer.aer_40_17

Cited by 12 publications

(12 citation statements)

References 12 publications

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“…This may be attributed to the high lipid solubility leading to rapid tissue uptake of both fentanyl and nalbuphine. This complies with Prabhakaraiah et al’s (2017) study, which documented comparable sensory and motor onset between fentanyl and nalbuphine in lower abdominal surgeries, although fentanyl provided a statistically early onset of sensory than nalbuphine in Gurunath and Madhusudhana’s (2018) trial of lower abdominal surgeries and Bisht and Rashmi’s (2017) study in total abdominal hysterectomy patients. In contrast, Ahluwalia et al (2015) observed earlier onset of sensory block in the nalbuphine group than in the control group.…”

Section: Discussionsupporting

confidence: 88%

“…Moustafa et al’s (2016) study also demonstrated prolonged duration of analgesia and a reduced visual analogue score (VAS) with nalbuphine in caesarean section patients. In contrast, Prabhakaraiah et al (2017) found higher VAS pain scores in the nalbuphine group undergoing lower abdominal surgeries. Since our study did not examine the postoperative VAS score and analgesic requirement, we can neither support nor refute these findings.…”

Section: Discussionmentioning

confidence: 71%

“…A semisynthetic opioid analgesic, nalbuphine, is a kappa receptor agonist and µ receptor antagonist (Zarr et al 1986). Nalbuphine is readily available and cheap, and has low abuse potential with few µ receptor side effects of nausea, vomiting and pruritis (Prabhakaraiah et al 2017). It also augments postoperative analgesia and has no documented evidence of neurotoxicity (Ahmed et al 2016, Mukherjee et al 2011).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of fentanyl and nalbuphine as adjuvants to intrathecal 0.5% bupivacaine in lower limb surgeries: A randomised double-blind prospective study

Geetha

Rudrakshala

Kar

et al. 2022

Journal of Perioperative Practice

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Introduction: Local anaesthetics used in spinal anaesthesia have a limited duration of action. To prolong postoperative analgesia, adjuvants, mainly opioids, are used. As µ agonist drugs have side effects, other receptor agonists are considered. Nalbuphine is a safe and effective kappa agonist adjuvant. Aim: To compare the analgesic efficacy between fentanyl and nalbuphine adjuvants added to 3 mL of 0.5% intrathecal hyperbaric bupivacaine. Materials and Methods: This prospective, double-blind, comparative study was conducted in 60 patients of either sex belonging to the American Society of Anesthesiologists classes I and II aged 18–65 years undergoing lower limb surgery with entropy monitoring, randomly allocated into two groups. Group F (n = 30) received 0.5% hyperbaric bupivacaine (3 mL) + 25 µg (0.5 mL) fentanyl. Group N (n = 30) received 0.5% hyperbaric bupivacaine (3 ml) + 0.8 mg (0.5 mL) nalbuphine intrathecally. Hemodynamics, entropy, motor and sensory block characteristics, and complications were noted. Results: The nalbuphine group had a significantly longer two-segment regression time of sensory blockade and extended analgesia duration than the fentanyl group. Haemodynamics, entropy, time for onset of sensory and motor blockade and adverse effects were comparable in both groups. Conclusion: Nalbuphine prolongs sensory blockade and postoperative analgesia duration with minimal side effects and is a safe intrathecal adjuvant.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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Comparison of fentanyl and nalbuphine as adjuvants to intrathecal 0.5% bupivacaine in lower limb surgeries: A randomised double-blind prospective study

Geetha

Rudrakshala

Kar

et al. 2022

Journal of Perioperative Practice

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“…By acting on μ1 and μ2 receptors, fentanyl is a stronger agonist than nalbuphine to produce analgesia and respiratory depression, and by acting on kappa receptors, nalbuphine may provide better effects of analgesia and sedation ( Chen et al, 1993 ). Specifically, nalbuphine acts as a moderate-efficacy partial agonist or antagonist of the µ-opioid receptor (MOR) and as a high-efficacy partial agonist of the κ-opioid receptor (KOR) ( Schmidt et al, 1985 ; Chen et al, 1993 ), which has the potential to maintain or even enhance μ-opioid-based analgesia while simultaneously mitigating the µ-opioid side effects ( Prabhakaraiah et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Postoperative Analgesic Effects Between Nalbuphine and Fentanyl in Children Undergoing Adenotonsillectomy: A Prospective, Randomized, Double-Blind, Multicenter Study

et al. 2020

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Objective: There is no universal agreement on optimal pharmacological regimens for pain management during surgeries. The aim of this study to compare the postoperative analgesic effects of nalbuphine with fentanyl in children undergoing adenotonsillectomy.Design, Setting, Participants: We conducted a prospective, randomized, double-blind, non-inferiority and multicenter trial in 311 patients admitted to four different medical facilities in China from October 2017 to November 2018.Main Outcome Measure: The primary outcome was postoperative pain score. The secondary outcomes were as follows: the numbers of patients who developed moderate or severe pain (FLACC ≥4 points); time to first rescue analgesic top up and the actual number of rescue pain medicine given in pain control in post-anesthesia care unit (PACU), and additional analgesics requirement (received ≥2 rescue analgesics or/and other analgesics except study medications administered in PACU and ward); emergence and extubation time; Waking up time; time of PACU stay, and other side effects (desaturation, nausea/vomiting etc.).Results: A total of 356 children were screened and 322 patients were randomized. The mean age was 5.8 (5.5, 6.1) in the nalbuphine group and 5.6 (5.3, 5.8) in the fentanyl group (p = 0.2132). FLACC score of nalbuphine group was lower than that of fentanyl group upon patients' arrival at PACU (p < 0.05). The time to first required rescue dose of pain drug for nalbuphine group was longer than for the fentanyl group (2.5 vs 1.2 h, p < 0.0001). Only one patient (0.6%) in nalbuphine group presented a slow respiratory rate (RR) at 9/min while 29 patients (18.5%) in fentanyl group developed slow RR ≤10/min in PACU. Meanwhile, SpO2 was lower in the fentanyl group at 10 min after patients’ arrival in PACU (p < 0.05). The other profiles observed from these two drug groups were similar.Conclusion: Nalbuphine provided better pain relief with minimal respiration depression than fentanyl in children undergoing Adenotonsillectomy.

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“…Based on the previous study by Prabhakaraiah et al [ 8 ], the mean duration of postoperative analgesia was taken into consideration, and the duration was 180.50 ± 34.58 in group BN (nalbuphine group) and 198.67 ± 45.67 in group BF (fentanyl group) with 80% power and at a 5% level of significance. The sample size required in each group was taken as 79, and 5% dropouts were taken into consideration.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Postoperative Analgesia Between Intrathecal Nalbuphine and Intrathecal Fentanyl in Infraumbilical Surgeries: A Double-Blind Randomized Controlled Trial

Jananimadi,

Arish,

Hariharasudhan

et al. 2024

Cureus

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Introduction: Spinal anesthesia is a widely used regional anesthesia technique for surgeries below the umbilicus, but postoperative analgesia is of major concern due to the relatively short duration of the local anesthetic. Various drugs were used as an additive to local anesthetic to prolong the duration of postoperative analgesia. This study aims to compare the efficacy of nalbuphine and fentanyl as an intrathecal additive along with local anesthetic. Methodology: A total of 166 patients aged between 18 and 65 years belonging to the American Society of Anesthesiologists (ASA) I and II undergoing elective infraumbilical surgeries were included in the prospective double-blind randomized controlled trial. The patients were allocated into two groups of 83 each. Group N was given 2.5 mL of 0.5% bupivacaine + 1 mg of nalbuphine (0.5 mL), and group F received 2.5 mL of 0.5% bupivacaine + 25 mcg fentanyl (0.5 mL). Both groups were compared for postoperative analgesia, onset and duration of both sensory and motor blockade, intraoperative hemodynamics, and side effects. Results: All demographic data, hemodynamic parameters, and side effects were not statistically significant among the two groups. However, other parameters, such as the mean duration of analgesia, which was 267.27 ± 172.099 minutes in group N and 161.35 ± 14.957 minutes in group F; meantime for the onset of sensory blockade, which was 3.94 ± 1.769 minutes in group N and 5.94 ± 0.929 minutes in group F; onset of complete motor blockade, which was 7.10 ± 1.858 minutes in group N and 11.61 ± 1.218 minutes in group F; duration of motor blockade, which was 182.57 ± 13.011 minutes in group N and 112.53 ± 7.389 minutes in group F; and mean time taken for two-segment regression, which was 118.20 ± 12.61 minutes in group N and 113.72 ± 8.84 minutes in group F, were all comparable between the two groups. Conclusion: Nalbuphine was found to be more efficacious for prolongation of postoperative analgesia with better hemodynamic stability.

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“Comparison of nalbuphine hydrochloride and fentanyl as an adjuvant to bupivacaine for spinal anesthesia in lower abdominal surgeries:” A randomized, double-blind study

Cited by 12 publications

References 12 publications

Comparison of fentanyl and nalbuphine as adjuvants to intrathecal 0.5% bupivacaine in lower limb surgeries: A randomised double-blind prospective study

Comparison of fentanyl and nalbuphine as adjuvants to intrathecal 0.5% bupivacaine in lower limb surgeries: A randomised double-blind prospective study

Comparison of Postoperative Analgesic Effects Between Nalbuphine and Fentanyl in Children Undergoing Adenotonsillectomy: A Prospective, Randomized, Double-Blind, Multicenter Study

Comparison of Postoperative Analgesia Between Intrathecal Nalbuphine and Intrathecal Fentanyl in Infraumbilical Surgeries: A Double-Blind Randomized Controlled Trial

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