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2013 Month : August Volume : 2 Issue : 33 Page : 6196-6206POSTOPERATIVE ANALGESIC EFFICACY OF INTRATHECAL TRAMADOL VERSUS NALBUPHINE ADDED TO BUPIVACAINE IN SPINAL ANAESTHESIA FOR LOWER LIMB ORTHOPAEDIC SURGERY
Devendra Verma1, Udita Naithani2, Dharm Chand Jain3, Ajay Singh4
CORRESPONDING AUTHOR:
Dr. Dharm Chand Jain,
131, M Road, Bhupalpura,
Udaipur (Rajasthan),
India – 313001.
Email- drdharmbkn@rediffmail.com
ABSTRACT: BACKGROUND: Effect of adding intrathecal tramadol and nalbuphine to local anaesthetics in spinal anaesthesia is not much studied. STUDY DESIGN: A prospective, randomised double blind placebo controlled study. METHODS: 90 adult patients of ASA grade I-II scheduled for lower limb orthopaedic surgery under spinal anaesthesia were randomised to three groups of 30 each destined to receive 2.5ml (12.5mg) hyperbaric bupivacaine (0.5%) along with 1 ml of either normal saline (Group C) 50mg tramadol (Group T) or 2mg nalbuphine (Group N), making intrathecal drug volume to 3.5ml in each group. Sensory-motor block characteristics, postoperative analgesia in terms of VAS score, time to first rescue analgesic (duration of analgesia) and rescue analgesic consumption (tramadol) in 24 hours were compared in three groups. RESULTS: All three groups were comparable regarding onset and extent of sensory and motor block, (p>0.05). However, time to two dermatomal regression and time for complete motor recovery were significantly longer in Group N than in Group T than in Group C,(p<0.05). Duration of analgesia was significantly longer in Group N (378.0±35.72 min ≈6.3hr) as compared to Group C (234.0±24.10min ≈3.9) (p=0.000) and Group T (260.0±26.52 min ≈4.3hr) (p=0.00) while Group C and Group T were comparable. CONCLUSION: We conclude that addition of intrathecal nalbuphine 2mg is effective in enhancing postoperative analgesia as compared to when bupivacaine was used alone or along with tramadol.
KEY WORDS: Postoperative analgesia, intrathecal opioids, nalbuphine, tramadol.