Intraoperative epidural nalbuphine bupivacaine analgesia: a comparative study

Epidural analgesia and anesthesia proved to be an excellent method of anesthesia in patients undergoing lower abdominal operations. Smaller doses of drugs are needed to achieve adequate analgesia and minimal side effects when given intrathecally or epidurally. The study was designed to compare the analgesic effect of epidural nalbuphine-bupivacaine to that of epidural bupivacaine alone. Nalbuphine-bupivacaine was also compared to other epidural opioids' analgesic effects. It was conducted on 100 patients scheduled for lower abdominal surgery. They were divided into five groups receiving bupivacaine [I], nalbuphine [II], morphine [III], fentanyl [IV] and pethidine [V] as an adjuvant to bupivacaine. The onset, duration of action of each drug, effects on pain scores, hemodynamics, respiratory rate, oxygen saturation, blood gases, and side effects were recorded after drug administration and over the next 12 h. Nalbuphine produced rapid onset analgesia 8-15 min, with a duration of 3-6 hours, perfect hemodynamic stability, minimal side effects [drowsiness and dysphoria] compared to other narcotics. Morphine with local anesthetic produced excellent analgesia 15-30 min of onset and duration of 6-12 hours but with liability to delayed respiratory depression and other side effects. Fentanyl has rapid onset of action and very effective analgesia for 1-3 hours with higher risk of respiratory depression than morphine. Pethedine given epidurally produced excellent analgesia of same onset as morphine, duration of 4-6 hours and may precipitate early respiratory depression

TIVA: comparative study between different techniques

This study was carried out on 60 adult patients of both sexes with age ranged between 20 and 50 years, they underwent surgical procedures that were expected to last about one hour. Patients were allocated into three equal groups. Each group was subjected to a different anesthetic techniques. The concentration of cortisol and glucose increased in the three different groups during surgery and further significant increase was observed on recovery. This indicated that the three different groups were subjected to comparable stress. There was little difference in the recovery time between the three groups as assessed by Steward coma scale. Although the ketamine-midazolam group and the propofol-ketamine group showed a slightly longer duration for recovery, this is due to the re-entry of ketamine from the peripheral to the central compartment. Also, propofol was effective in eliminating the side effects of the subanesthetic doses of ketamine