Efficacy of nalbuphine as an adjuvant to 0.5% ropivacaine for ultrasound-guided supraclavicular brachial plexus block in upper limb surgeries: A prospective randomized double-blind study

Jain, Kavita; Sethi, Surendra Kumar; Gupta, Suman Lata; Khare, Arvind

doi:10.4103/theiaforum.theiaforum_31_19

Cited by 4 publications

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“…Of these, seven were excluded because of irrelevant comparator (n = 5) and not being RCTs (n = 2). Subsequently, a total of 17 RCTs (1104 patients) were included in this systematic review and meta‐analysis 21,24‐39 . A flow chart for the filtering process of studies is depicted in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…The 17 trials included a total of 1104 patients, among which 582 patients received nalbuphine as an adjuvant and 522 patients received placebo in context of BPB for upper extremity surgical procedures. For the method of nerve block localization, one study performed infraclavicular nerve block under ultrasound guidance, 21 two studies performed supraclavicular nerve block with nerve stimulation, 27,33 and the remaining 14 studies performed BPB through the supraclavicular approach using ultrasound guidance 24‐26,28‐32,34‐39 . The type and concentration of local anaesthetics were also varied: eight trials investigated the combination of nalbuphine with bupivacaine (0.375% or 0.5%), 21,25,30,33,35‐38 six with ropivacaine (0.5% to 0.75%), 26,29,31,32,34,39 one study added nalbuphine into bupivacaine (0.5%) and lidocaine (0.2%) mixture, 28 and 2 with levobupivacaine (0.25% or 0.5%) 24,27 .…”

Section: Resultsmentioning

confidence: 99%

“…Subsequently, a total of 17 RCTs (1104 patients) were included in this systematic review and meta‐analysis. 21 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 A flow chart for the filtering process of studies is depicted in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

“…For the method of nerve block localization, one study performed infraclavicular nerve block under ultrasound guidance, 21 two studies performed supraclavicular nerve block with nerve stimulation, 27 , 33 and the remaining 14 studies performed BPB through the supraclavicular approach using ultrasound guidance. 24 , 25 , 26 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 The type and concentration of local anaesthetics were also varied: eight trials investigated the combination of nalbuphine with bupivacaine (0.375% or 0.5%), 21 , 25 , 30 , 33 , 35 , 36 , 37 , 38 six with ropivacaine (0.5% to 0.75%), 26 , 29 , 31 , 32 , 34 , 39 one study added nalbuphine into bupivacaine (0.5%) and lidocaine (0.2%) mixture, 28 and 2 with levobupivacaine (0.25% or 0.5%). 24 , 27 Local anaesthetic solutions were injected in volumes ranging from 18 to 30 mL.…”

Section: Resultsmentioning

confidence: 99%

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A meta‐analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper‐limb orthopaedic trauma surgery

Shi

Dong

Chen

et al. 2022

International Wound Journal

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The adjuvant effectiveness of nalbuphine in context of brachial plexus block (BPB) in patients undergoing upper‐limb orthopaedic trauma surgery has remained uncertain. The purpose of this meta‐analysis was to evaluate the analgesic benefit of mixing nalbuphine into local anaesthetics in BPB for wound pain from upper‐limb trauma surgery. Primary outcome was the duration of analgesia. Seventeen trials (1104 patients) were analysed. Patients receiving nalbuphine have an increased weighted mean difference (WMD) 95% confidence interval of the duration of analgesia by 186.91 minutes (133.67 to 240.16) (P < 0.001). Compared to placebo, nalbuphine shorten the onset time of sensory and motor block by WMD of 2.59 (1.27 to 3.92) and 3.06 minutes (1.65 to 4.48) (P < 0.001), respectively. Meanwhile, nalbuphine prolonged the durations of sensory and motor block (P < 0.001). Qualitative and quantitative synthesis revealed no differences with regard to the outcomes related to side‐effects. There is moderate‐quality evidence that the addition of nalbuphine to local anaesthetics for BPB in patients undergoing upper‐limb orthopaedic trauma surgery significantly prolongs the duration of analgesia, while preserving a similar safety‐profile compared with local anaesthetics alone. However, these benefits should be further weighed against nalbuphine‐related neurological safety in future studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

A meta‐analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper‐limb orthopaedic trauma surgery

Shi

Dong

Chen

et al. 2022

International Wound Journal

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“…24 The addition of nalbuphine to levobupivacaine did not affect the hemodynamics at any time interval during the entire study period, as also observed by many authors. 20,21,25 Drug-related complications like nausea, vomiting, pruritis, and dry mouth were more in the nalbuphine group but did not cause any significant discomfort to the patients. These could be managed conservatively.…”

Section: Discussionmentioning

confidence: 96%

Twenty-four-hour Requirement of Rescue Analgesia after Upper Limb Surgery under Supraclavicular Brachial Plexus Block: A Role of Nalbuphine as an Adjuvant to Levobupivacaine

Kumari¹,

Gupta²,

Aggarwal³

2021

AMEI's Current Trends in Diagnosis &Amp; Treatment

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Background: Opioids have been used with peripheral nerve blocks for its synergistic effect to enhance the postoperative analgesic effectiveness of regional block. Nalbuphine, a newer opioid with an analgesic equivalence of morphine, has a ceiling effect on respiratory depression. The aim of the present study was to evaluate the effect of nalbuphine when used as an adjuvant to levobupivacaine on 24-hour postoperative analgesic requirement after brachial plexus block (BPB). Materials and methods: Sixty adult patients of either sex of American Society of Anesthesiologists (ASA) physical status I and II were randomized into two groups of 30 each to receive a total volume of 30 mL of study drug for supraclavicular brachial plexus block (SBPB): Group N-29 mL of 0.5% levobupivacaine with 1 mL of 10 mg nalbuphine; Group S-29 mL of 0.5% levobupivacaine with 1 mL of normal saline. Patients observed for 24-hour postoperative mean requirement of rescue analgesia, that is, diclofenac sodium, block characteristics, visual analog scale (VAS) scores, and the associated complications. Results: Demographic profile was comparable between the two groups. The mean dose of rescue analgesic required between the groups N and S was 127.5 ± 34.96 mg and 150 ± 37.5 mg (p = 0.000), respectively. The average VAS score at different time intervals was highly significant between the two groups (p <0.05). Similarly, block characteristics were statistically significant between the two groups; that is, onset was early, but the duration was prolonged in group N (p <0.05). Complications, although more in group N, were minor and statistically insignificant (p >0.05). Conclusion: Nalbuphine 10 mg as an adjunct to 0.5% levobupivacaine significantly reduced the requirement of rescue analgesia compared to placebo, with no significant major adverse effects.

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

Schubert,

Seneviratne,

Stolz

et al. 2023

European Journal of Anaesthesiology

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BACKGROUNDPeripheral regional anaesthesia is frequently used for upper extremity surgery. To prolong the duration of analgesia, adjuvants can be added to single-injection local anaesthetics. Despite attempts to compare several adjuvants in pairwise meta-analyses, a comprehensive comparison is still missing.OBJECTIVEThe objective of this network meta-analysis was to determine the effectiveness of adjuvants in upper extremity peripheral nerve blocks.DESIGNA systematic review of randomised controlled trials with network meta-analyses.DATA SOURCESA literature search in Embase, CENTRAL, MEDLINE and Web of Science was performed up to March 2023.ELIGIBILITY CRITERIARandomised trials comparing different adjuvants injected perineurally in peripheral upper extremity nerve blocks were eligible. Frequentist network meta-analysis was conducted using a random effects model with physiological saline as the comparator. The primary endpoint was the ratio of means (ROM) of the duration of analgesia.RESULTSThe review included 242 randomised controlled trials with a total of 17 391 patients. Twenty-eight adjuvants were compared in the largest networks. Most network estimations consisted of a high proportion of direct evidence. Fourteen adjuvants increased the duration of analgesia significantly by the following factors, ROM [95% confidence interval (CI)]: dexamethasone 1.95 (1.79 to 2.13), buprenorphine 1.83 (1.51 to 2.24), butorphanol 1.84 (1.41 to 2.39), potassium chloride 1.89 (1.15 to 3.11), dexmedetomidine 1.70 (1.59 to 1.81), sufentanil 1.70 (1.27 to 2.29), ketorolac 1.68 (1.24 to 2.27), midazolam 1.55 (1.24 to 1.94), tramadol 1.52 (1.32 to 1.75), nalbuphine 1.50 (1.30 to 1.72), morphine 1.43 (1.09 to 1.88), magnesium sulfate 1.42 (1.20 to 1.67), clonidine 1.36 (1.24 to 1.50) and fentanyl 1.23 (1.08 to 1.40). Inconsistency in network meta-analysis was substantial. Overall side effect rates were low with all adjuvants.CONCLUSIONThe best interventions to prolong the duration of analgesia were dexamethasone, followed by dexmedetomidine, opioids, electrolytes, ketorolac and midazolam. There are general concerns about the quality of underlying studies and the risk of publication bias.TRIAL REGISTRATIONPROSPERO 2018 CRD42018115722

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Efficacy of nalbuphine as an adjuvant to 0.5% ropivacaine for ultrasound-guided supraclavicular brachial plexus block in upper limb surgeries: A prospective randomized double-blind study

Cited by 4 publications

References 0 publications

A meta‐analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper‐limb orthopaedic trauma surgery

A meta‐analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper‐limb orthopaedic trauma surgery

Twenty-four-hour Requirement of Rescue Analgesia after Upper Limb Surgery under Supraclavicular Brachial Plexus Block: A Role of Nalbuphine as an Adjuvant to Levobupivacaine

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

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