Chatrath Veena, Attri Joginder Pal, Bala Anju, Khetarpal Ranjana, Ahuja Deepti, Kaur Sawinder
Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India.
Anesth Essays Res. 2015 Sep-Dec;9(3):326-30. doi: 10.4103/0259-1162.158004.
The challenging task of postoperative pain relief comes within the realm of the anesthesiologist. Combined spinal epidural (CSE) anesthesia can be used as the sole technique for carrying out surgical procedures and managing postoperative pain using various drug regimes. Epidural administration of opioids in combination with local anesthetic agents in low dose offers new dimensions in the management of postoperative pain.
Comparative evaluation of bupivacaine hydrochloride with nalbuphine versus bupivacaine with tramadol for postoperative analgesia in lower limb orthopedic surgeries under CSE anesthesia to know the quality of analgesia, incidence of side effects, surgical outcome and level of patient satisfaction.
A prospective, randomized and double-blind study was conducted involving 80 patients of American Society of Anesthesiologists physical status I and II coming for elective lower limb orthopedic surgeries carried under spinal anesthesia.
Anesthesia was given with 0.5% of 2.5 ml bupivacaine intrathecally in both the groups. Epidurally 0.25% bupivacaine along with 10 mg nalbuphine (group A) or tramadol 100 mg (group B) diluted to 2 ml to make a total volume of 10 ml was administered at sensory regression to T10.
The data were collected, compiled and statistically analyzed with the help of MS Excel, EPI Info 6 and SPSS to draw the relative conclusions.
The mean duration of analgesia in group A was 380 ± 11.49 min and in group B was 380 ± 9.8 min. The mean sedation score was found to be more in group B than group A. The mean patient satisfaction score in group A was 4.40 ± 0.871 and in group B was 3.90 ± 1.150 which was found to be statistically significant (P < 0.05). We concluded that the addition of nalbuphine with bupivacaine was effective for postoperative analgesia in terms of quality of analgesia and patient satisfaction score as compared to tramadol.
术后疼痛缓解是一项具有挑战性的任务，属于麻醉医生的工作范畴。腰麻-硬膜外联合麻醉（CSE）可作为实施外科手术及采用各种药物方案管理术后疼痛的唯一技术。低剂量阿片类药物与局部麻醉药联合硬膜外给药为术后疼痛管理提供了新的途径。
比较盐酸布比卡因联合纳布啡与布比卡因联合曲马多用于CSE麻醉下下肢骨科手术术后镇痛的效果，以了解镇痛质量、副作用发生率、手术效果及患者满意度。
进行一项前瞻性、随机、双盲研究，纳入80例美国麻醉医师协会身体状况分级为I级和II级、前来接受腰麻下择期下肢骨科手术的患者。
两组均鞘内注射2.5 ml 0.5%布比卡因进行麻醉。在感觉平面消退至T10时，硬膜外给予0.25%布比卡因，A组加入10 mg纳布啡，B组加入100 mg曲马多，均稀释至2 ml，使总体积达到10 ml。
借助MS Excel、EPI Info 6和SPSS收集、整理并统计分析数据，以得出相关结论。
A组平均镇痛时间为380±11.49分钟，B组为380±9.8分钟。发现B组平均镇静评分高于A组。A组平均患者满意度评分为4.40±0.871，B组为3.90±1.150，差异具有统计学意义（P<0.05）。我们得出结论，与曲马多相比，布比卡因联合纳布啡在镇痛质量和患者满意度评分方面对术后镇痛有效。
