Comparison of intrathecal fentanyl and nalbuphine: a prospective randomized controlled study in patients undergoing total abdominal hysterectomy

Objectives: 0.5% bupivacaine used in subarachnoid block provides only about 3 hours of analgesia. Opioids especially morphine and fentanyl are used as adjuvants to produce extended postoperative analgesia. Nalbuphine is an agonist antagonist and does not require a narcotic license, which is a must for procuring other opioids, so is easily available even in peripheral hospitals. This study was carried out to evaluate the efficacy of nalbuphine versus fentanyl as intrathecal adjuvant

Methodology: One hundred ASA 1-3 patients, aged 30-65 years posted for elective total abdominal hysterectomy [TAH] were included in this study and were randomly divided into two groups of fifty each. Group FB received 15 mg of 0.5% bupivacaine [3 ml] plus 25 micro g of fentanyl [0.5 ml] and Group NB received 15 mg 0.5% bupivacaine [3 ml] plus 1 mg nalbuphine [0.5 ml]. No sedative or analgesic was given preoperatively. The parameters noted were; the time for sensory block to reach T10 dermatome, time for the sensory level to fall from T6 to T8 dermatome, time for the first request of rescue analgesia, duration of motor block and any untoward side effect or complications. The statistical analysis was performed by STATA 11.2 [College Station TX USA]. Students t-test were performed for to find the significance difference between the study parameters

Results: The onset of sensory blockade, time to attain peak sensory block and complete motor block was significantly faster in Group FB [p < 0.001]. The duration of motor block was comparable in both the groups. The time for sensory block to regress by two segments was significantly longer in Group NB, 97.72 +/- 9.50 min, than in Group FB, 88.88 +/- 9.48 min. The time to first analgesic requirement in Group NB was 460.78 +/- 77.98 min compared to 283.44 +/- 78.97 min in Group FB [p < 0.001]. No statistical difference was seen in terms of adverse effects. Two patients in both groups complained of nausea. Hypotension and pruritus were seen in two and one patient respectively in Group FB

Conclusion: Although the time to onset and peak sensory level is longer with nalbuphine as intrathecal adjuvant than fentanyl, time for sensory level to regress by two segments and the postoperative analgesia time is longer with nalbuphine. So, nalbuphine is a good adjuvant in spinal anesthesia and has an advantage in centers without narcotics license

Comparative analysis for metal binding capacity of cysteine by using UV-VIS spectrophotometer.

The metal binding capacity of cysteine with three different metals Nickel, Copper and Lead was studied using UV-Vis spectrophotometer for which absorbance values were taken after interaction of cysteine with metal salt solutions (10ppm and 100ppm). Before taking above absorbance dilution factor was set using cysteine stock. The increase in peak intensity was observed when metal salt solution and metal saltcysteine solution were compared. Based on peak shift and peak intensity finally it can be concluded that the binding capacity of cysteine with Nickel is more, followed by lead and copper. The normal chromophore activity in cysteine is due to the sulphur in which the transition takes place from non bonding orbital’s to the excited antibonding orbital in the range of 210-215nm range. The binding of the metals with cysteine may affect the chromophore activity and may also lead to structural damage of the chromophore. This can give the decrease in the peak intensity or the complete shift in the peak. These results suggest that cysteine metal binding ability can be used for the removal of the metals in water purification. Also this property can be used in removal of metals from our body considering the fact that cysteine may not show adverse effect in the system. So we can go for designing a new type of drug containing cysteine which helps to prevent the accumulation of such metals and thus prevent us from adverse effect.