Intrathecal nalbuphine as an adjuvant to subarachnoid block: What is the most effective dose?

Abstract

Background:Nalbuphine has been used intrathecally as an adjuvant in previous studies, but none clearly state the most effective dose of nalbuphine. The purpose of our study was to establish the effectiveness of intrathecal nalbuphine as an adjuvant, compare three different doses and determine the optimum dose with prolonged analgesic effect and minimal side-effects.Materials and Methods:In this prospective, randomized, double-blinded, controlled study, 100 ASA I and II patients undergoing lower limb orthopedic surgery under subarachnoid block (SAB), were randomly allocated to four groups: A, B, C and D, to receive 0.5 ml normal saline (NS) or 0.2, 0.4 and 0.8 mg nalbuphine made up to 0.5 ml with NS added to 0.5% hyperbaric bupivacaine 12.5 mg (total volume 3 ml), respectively. The onset of sensory and motor blockade, two-segment regression time of sensory blockade, duration of motor blockade and analgesia, visual analogue scale (VAS) pain score and side-effects were compared between the groups.Results:Two-segment regression time of sensory blockade and duration of effective analgesia was prolonged in groups C (0.4 mg nalbuphine) and D (0.8 mg nalbuphine) (P<0.05), and the incidence of side-effects was significantly higher in group D (P<0.05) compared with the other groups.Conclusion:Nalbuphine used intrathecally is a useful adjuvant in SAB and, in a dose of 0.4 mg, prolongs postoperative analgesia without increased side-effects.

Ultrasound Guided Transversus Abdominis Plane Block versus Intrathecal Nalbuphine Injection for Postoperative Analgesia in Preeclamptic Patients Undergoing Cesarean Section

“…The same result reported by Tiwari et al [18] but by using smaller dose (0.2 and 0.4 mg) . Supporting the previous results, Ahmed et al [19] concluded that significant increase in postoperative duration of analgesia compared with the vehicle-treated group in abdominal operation following administration of intrathecal nalbuphine in doses of 0.8,1.6 and 2.4 mg .The same results were obtained by both Kumaresan and Raj [20] and Mukherjee et al [21] who used 0.4, 0.8 mg of intrathecally nalbuphine in patients scheduled in optional lower limb surgeries and show significant analgesia prolongation. On the other hand, Verma et al [22] concluded intrathecal nalbuphine 2 mg is effective in enhancing postoperative analgesia compared to bupivacaine alone or along with tramadol.…”

Intrathecal nalbuphine versus ketamine with hyperbaric bupivacaine in lower abdominal surgeries

“…The mean time taken to achieve maximum motor block of Bromage 3 was earlier in Group N, but the results were comparable and statistically nonsignificant. In a study done by Mukherjee et al .,[ 13 ] it was seen that onset of motor block was early in group containing 0.8 mg nalbuphine and duration of motor block was also more in that group, but the difference was insignificant as seen in our study also. In a study done by Jain et al .,[ 14 ] it was observed that there was early onset of motor block in ketamine group along with longer duration of motor block although the difference was insignificant, as observed in our study.…”

Postoperative analgesia with intrathecal nalbuphine versus intrathecal fentanyl in cesarean section: A double-blind randomized comparative study

“…compared 0.2, 0.4, and 0.8 mg of intrathecal nalbuphine in lower limb orthopedic surgery and recommended 0.4 mg of nalbuphine as the optimal dose without any side effects. [ 6 ]…”