Intrathecal nalbuphine versus fentanyl as an adjuvant to bupivacaine in spinal anesthesia for elective cesarean section: a randomized double-blind study

Ahmed, Farahat I

doi:10.4103/roaic.roaic_109_17

Cited by 12 publications

(11 citation statements)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Its onset is slow with short duration of postoperative analgesia. 3,4 Adjuvant drugs added to bupivacaine intrathecally improve the duration and quality of the blockade and prolong the postoperative analgesia. Various adjuvants are being used such as alpha 2 agonists, neostigmine, opiates, ketamine etc, yet no drug has been identified to specifically inhibit nociception without side effects.…”

Section: Introductionmentioning

confidence: 99%

<p>Nalbuphine versus Midazolam as an Adjuvant to Intrathecal Bupivacaine for Postoperative Analgesia in Patients Undergoing Cesarean Section</p>

Amin¹,

Ibrahem²,

Salem³

2020

JPR

View full text Add to dashboard Cite

Background and Purpose: Adding adjuvants to intrathecal hyperbaric bupivacaine provides long analgesic duration with less adverse effects. The aim of this study was to compare intrathecal nalbuphine versus midazolam in patients undergoing cesarean section. Clinical Trial ID: NCT03918187. Patients and Methods: This was a prospective randomized controlled study conducted on 90 females undergoing cesarean section under spinal anesthesia who were randomly allocated to three equal groups of 30 patients each: group C received hyperbaric bupivacaine 12.5 mg plus 0.5 mL saline, group N received hyperbaric bupivacaine 12.5 mg plus 1 mg nalbuphine, group M received hyperbaric bupivacaine 12.5 mg plus 2.5 mg midazolam. The onset and duration of sensory and motor block, effective analgesic time, analgesic requirements, adverse effects, sedation, and Apgar scores were recorded. Results: There was significant rapid onset of sensory and motor block (1.95±.44 and 3.50 ±0.43 min) with slower regression of sensory block and time to bromage I (211.6±13.2 and 219.8±20.2 min) in group N compared to groups M, C (p < 0.001), with statistically significant rapid onset and long duration of both blocks in group M compared to C (p<0.001). The effective analgesic time was significantly prolonged in group N (263.7 ±16.3) compared to groups M and C (224.2 ± 18.6, 185.5±17.45), respectively, (p<0.001) and prolonged in group M compared to C (p<0.001), with increase in analgesic requirement in group C compared to groups N and M (p<0.001) and no significant difference between groups N and M. There was higher sedation score in groups N, M (1.78±0.63, 2.75±0.54), respectively, compared to group C (0.61±0.12) (p<0.001) with lower Apgar score in group M (6.9±0.73) at one minute than in groups N, C (7.1±0.91, 7.7±0.84) (p<0.001). There was no significant difference between groups regarding the adverse effects. Conclusion: Adding 1 mg nalbuphine to 12.5 mg hyperbaric bupivacaine provided more effective postoperative analgesia than adding 2.5 mg midazolam, with less non-significant adverse effects in midazolam group in patients undergoing elective cesarean section.

show abstract

Section: Introductionmentioning

confidence: 99%

<p>Nalbuphine versus Midazolam as an Adjuvant to Intrathecal Bupivacaine for Postoperative Analgesia in Patients Undergoing Cesarean Section</p>

Amin¹,

Ibrahem²,

Salem³

2020

JPR

View full text Add to dashboard Cite

show abstract

“…When it interacts to kappa receptors, however, it exerts an agonistic action. As a result, it is an agonist-antagonist and it provides analgesic effects without causing mu adverse effects [9], [10], [11], [12].…”

Section: Discussionmentioning

confidence: 99%

“…Nalbuphine is an agonist-antagonist opioid that can reduce mu effects while increasing kappa effects. Its combination with mu agonists made mu-receptor associated adverse events less to occur and less severe, and it can also prevent spinal anesthesia caused shivering [9], [10], [11], [12].…”

Section: Introductionmentioning

confidence: 99%

A Comparison between Intrathecal Nalbuphine and Fentanyl for Intraoperative Pain Management during Uterine Exteriorization in Cesarean Section: A Randomized Controlled Trial

Mohamed

Elsonbaty

2021

Open Access Maced J Med Sci

View full text Add to dashboard Cite

BACKGROUND: Uterine exteriorization during cesarean section is linked to an increased incidence of visceral pain. AIM: This study explored the ability of intrathecal nalbuphine to alleviate this accompanied pain to be used as an effective safer alternative to fentanyl, as there is almost no study compared between these agents to alleviate visceral pain induced by uterine exteriorization. METHODS: This double-blinded randomized controlled research was done on 135 cases subjected to cesarean section with exteriorization of the uterus. Patients were randomized equally into F, N, and C groups which received 25 μg fentanyl, 800 μg nalbuphine, and 0.5 ml saline, respectively, added to intrathecal 0.5% hyperbaric bupivacaine. The occurrence of visceral and shoulder pain and their VAS, the need for rescue IV fentanyl, adverse events, hemodynamics, and Apgar scores were evaluated. RESULTS: The incidence of visceral pain was 22.2%, 24.4%, and 66.7% for Groups F, N, and C, respectively. Patients who needed rescue IV fentanyl were 6.7%, 11.1%, and 60% for Groups F, N, and C, respectively. The statistical difference regarding these parameters was highly significant (p < 0.0001) between C group and both F and N groups but insignificant between F and N groups. Nausea, shivering, itching, and bradycardia were significantly lower (p < 0.05) in N group in comparison to F and C. HR had a significant difference between F group and both N and C groups. CONCLUSION: Intrathecal nalbuphine is an effective safer alternative to fentanyl to control visceral pain induced by uterine exteriorization during cesarean delivery.

show abstract

“…In these patients, bradycardia occurs in the case of sympathetic block at the level of T1-4 (cardioaccelerator fibers) [ 8 ]. On the other hand, with block T1-4, compensatory tachycardia generally does not occur in response to hypotension [ 9 ]. Hypotension with systolic blood pressure less than 90 mmHg decreases uterine and placental perfusion, asphyxia, fetal acidosis and neonatal depression [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of an ephedrine infusion with lidocaine %5 for prevention of hypotension during spinal anesthesia in cesarean section

Pouryaghobi

Mashak

Kabir

et al. 2022

Annals of Medicine &Amp; Surgery

View full text Add to dashboard Cite

Background Spinal anesthesia is the method of choice for cesarean section and in most cases causes hypotension. Objective The aim of this study was to treat hypotension by ephedrine in order to prevent maternal and fetal complications, and also to determine the effective amount of ephedrine for reducing arterial hypertension in order to prevent its complications, including cardiac arrhythmias. Method This cross-sectional descriptive study was conducted on 131 patients. Mean arterial blood pressure (MAP) of the candidates for cesarean section in the supine position was measured and recorded as mean baseline blood pressure. 75 mg of lidocaine (5%) was used as spinal anesthesia, following which the average blood pressure was measured every 1 min. In the event of a decrease in the mean arterial blood pressure of at least 20% of the mean baseline blood pressure, ephedrine 0.1/mg/kg was injected intravenously and after 1 min of MAP was measured. Result The prevalence of hypotension was 89.30%. 25.60% of patients with hypotension had 30–34.99% reduction in MAP compared to baseline MAP. 12% patients had 40% drop in their MAP. 4 min following spinal anesthesia, the incidence of hypotension reduced by 20%. The average dose of ephedrine required to reduce the incidence of hypotension was 20.5 mg. Conclusion Reduction in MAP following spinal anesthesia using lidocaine is common. Ephedrine at the dose of 20 mg is effective to reduce the incidence of perioperative hypotension.

show abstract

Intrathecal nalbuphine versus fentanyl as an adjuvant to bupivacaine in spinal anesthesia for elective cesarean section: a randomized double-blind study

Cited by 12 publications

References 1 publication

<p>Nalbuphine versus Midazolam as an Adjuvant to Intrathecal Bupivacaine for Postoperative Analgesia in Patients Undergoing Cesarean Section</p>

<p>Nalbuphine versus Midazolam as an Adjuvant to Intrathecal Bupivacaine for Postoperative Analgesia in Patients Undergoing Cesarean Section</p>

A Comparison between Intrathecal Nalbuphine and Fentanyl for Intraoperative Pain Management during Uterine Exteriorization in Cesarean Section: A Randomized Controlled Trial

Comparison of an ephedrine infusion with lidocaine %5 for prevention of hypotension during spinal anesthesia in cesarean section

Contact Info

Product

Resources

About