Comparative study of analgesic effect of intrathecal nalbuphine and tramadol in patients undergoing vaginal hysterectomy
Aims: To compare the analgesic effect and block characteristics of intrathecal nalbuphine and tramadol in patients undergoing vaginal hysterectomy.
Settings and design: Prospective, double-blind, randomized study on 80 patients of age 20-60 years, undergoing vaginal hysterectomy under spinal anaesthesia.
Methods and Material: Random allocation in two groups, where group T and group N received 25 mg tramdol and 1 mg nalbuphine respectively along with 15 mg 0.5% hyperbaric bupivacine through intrathecal route. Drugs were administered at the L3-4 interspace with the patient in the sitting position. Spinal block was assessed by pin prick and modified bromage scale. In postoperative period time of first request of analgesia, number of rescue analgesia, the duration of motor block from the time of drug administration to the time when patient was able to lift his leg and the adverse effects were recorded. Quantitative variables were compared using Unpaired t-test/Mann-Whitney Test. Qualitative variables were correlated using Chi-Square test /Fisher’s exact test. A p value of <0.05 was considered statistically significant.
Results: group N achieved faster onset of sensory block than group T (Group N=2.74±0.46min, Group T= 3.9±0.37min) (p<.0001) Time to reach peak sensory level was lesser in nalbuphine group than tramadol group. (Group T= 8.65 ± 0.86 min, Group N=7.42 ± 0.92min) (p<.0001). Mean peak sensory level was statistically comparable in both groups (Group T= T6.5±0.89, Group N=T6.1±0.53) (p>0.05).
Conclusion: In terms of sensory and motor block characteristics, nalbuphine provides faster onset, faster peak of analgesia than tramadol. In terms of postoperative analgesia nalbuphine and tramadol were statistically similar.
Key message: This study establishes the efficacy of Nalbuphine (1mg) as an intrathecal adjuvant to 15 mg of 0.5% hyperbaric bupivacaine for enhancing the intraoperative sensory block and better haemodynamic stability than Tramadol (25 mg) as an intrathecal adjuvant. In terms of postoperative analgesia and motor block characteristics both the drugs are comparable.
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