Post-Operative Analgesic Efficacy of Nalbuphine Compared with Tramadol for Lower Limb Orthopaedic Surgeries-An Observational Study

Abstract

BACKGROUND Presence of pain is as old as that of humankind. From ancient times, pain has followed surgeons as well as anaesthesiologists like a shadow which is not seperable.1 Postoperative pain is an acute pain which can affect nearly all organ functions and can leads to postoperative period morbidity and mortality. Pharmacological treatment using intravenous opioids is an effective and popular method to treat the pain.2 In this study the researcher compared the analgesic efficacy and side effects of intravenousNalbuphine and Tramadol in those patients undergoing Lower limb Orthopaedic procedures. To investigate the effect of Nalbuphine and Tramadol on post-operative pain and to compare the side effects among Nalbuphine and Tramadol group in patient admitted in Travancore Medical College, Kollam during the period from January 2019 to September 2019. METHODS This study was a prospective observational study. The study population comprises, 140 patients falling within the inclusion criteria who had given consent for participating in this study. Sub arachnoid block is commonly followed in our Anesthesiologydepartment for Lower limb orthopaedic procedures 3 to 3.5ml of 0.5% hyperbaricbupivacaine via 25 G spinal needle. No analgesic or sedative will be given intra operatively.Patients who had received Injection Nalbuphine 0.15 mg/kg IV diluted till 10 ml volume innormal saline and Injection Tramadol 2 mg/kg IV diluted till 10 ml volume of normal salinewere grouped as N (n=70) and T (n=70) respectively. Post-operative pain was assessed usingVAS, onset of drug effect and duration of action of each dose of drug. Side effects of drugsassessed using the variables such as incidence of postoperative nausea and vomiting (PONV),Ramsay sedation scores, respiratory rate and SpO2. VAS score assessed initially every5 minutes till 15 minutes, then every 30 minutes till 2 Hrs, then 3 Hrs, 4 Hrs, 5 Hrs, 6 Hrs,8 Hrs, 12 Hrs, 16 Hrs, 20 Hrs and 24 Hrs. Ramsay sedation scores, respiratory rate and SpO2 were assessed initially every 5minute till 15minutes, every 30minute till 2 hours, then at 4 Hrs, 6 Hrs, 8 Hrs, 12 Hrs,16 Hrs, 20 Hrs and 24 Hrs duration. RESULTS From the results we found that with successive doses it Nalbuphine proven to be having significantly longer duration of analgesia than Tramadol after the third dose. Based on the VAS scores Group T is more effective in controlling pain initially, butlater on pain scores significantly less with Group N became more effective. Side effects likenausea and vomiting is comparable between two groups but incidence more in Group T.Respiratory depression side effects is also comparable between the two groups but incidencemore for Group N. CONCLUSIONS Nalbuphine 0.15 mg/kg can be an effective tool in the treatment of acutepostoperative pain in lower limb orthopaedic procedures. Both Nalbuphine and Tramadol canbe a good alternative in the multimodal therapy of acute postoperative analgesia. KEY WORDS Nalbuphine, Tramadol, Lower Limb Orthopaedic Surgeries, Sub Arachnoid Block