A comparative study of epidural 05% bupivacaine with nalbuphine and 05% bupivacaine with fentanyl in lower abdominal and lower limb surgeries

ABSTRACT

Background: Epidural opioids have unique advantages over conventional, intermittent IV/ IM administration, in that patients given epidural opioids have fewer respiratory complications and can be mobilized sooner in the postoperative period. Aim: To compare the effects of epidural 0.5%Bupivacaine with nalbuphine and 0.5% bupivacaine with fentanyl in lower abdominal and lower limb surgeries. Materials and methods: This prospective, randomized, single blind study, where in Epidural Nalbuphine (10 mg) with 0.5% bupivacaine and epidural fentanyl (50 g) with 0.5% bupivacaine in lower abdominal and lower limb surgeries. Results: There were statistically no significant difference between mean age, weight, gender, ASA grading, types of surgeries and baseline parameters in both groups. The duration of surgery and time of onset of sensory blockade, motor blockade and peak motor blockade were not statistically significant (p> 0.05). The duration of sensory blockade was highly significant (p < 0.01). Duration of motor blockade was not statistically significant (p > 0.05). Mean heart rates in both the groups were significant only at 6th, 7th, 8th, 9th and 10th hours. Mean arterial pressures in both the groups were significant only at 3rd, 6th, 7th, 8th, 9th and 10th hours. 30% of patients in group A had a pain score more than 4 during 6-12 hours of postoperative period as compared to 80% in group B. The pain scores were similar in both the groups in the first six hours of postoperative period. Number of rescue Nama Nagarjuna Chakravarthy, A Sagar, G. Venkateshwarlu. A comparative study of epidural 0.5% bupivacaine with nalbuphine and 0.5% bupivacaine with fentanyl in lower abdominal and lower limb surgeries. IAIM, 2018; 5(2) 124-134. Page 125 analgesics required in the first 24 hours of post-operative period in group B were significantly higher (p < 0.01) when compared with group A. 4 patients (13.2%) in Group B experienced respiratory depression which is significant statistically. Conclusions: Epidural Nalbuphine with 0.5%bupivacaine significantly prolongs the total duration of sensory blockade with better postoperative analgesia when compared to epidural fentanyl with 0.5%bupivacaine, with stable hemodynamics and less side effects.