Prabhakaraiah Umesh N, Narayanappa Archana B, Gurulingaswamy Shivakumar, Kempegowda Krishna, Vijaynagar Kiran A, Hanumantharayappa Nagarajaiah B, Ramegowda Diwakar S
Department of Anaesthesiology, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.
Department of Pharmacology, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.
Anesth Essays Res. 2017 Oct-Dec;11(4):859-863. doi: 10.4103/aer.AER_40_17.
Opioids have been favored as adjuvants to local anesthetics during spinal anesthesia. Nalbuphine, a μ-receptor antagonist and ĸ-receptor agonist, seems to be a suitable adjuvant to local anesthetics. The aim of this study was to compare postoperative analgesia and adverse effects of nalbuphine and fentanyl when used as an adjuvant to hyperbaric bupivacaine during spinal anesthesia.
Sixty patients belonging to the American Society of Anesthesiologists Physical Status I and II were randomly allocated into two groups of thirty each. Patients in bupivacaine nalbuphine group (Group BN) received 0.8 mg (0.3 ml) of nalbuphine with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine diluted to 3 ml and bupivacaine-fentanyl group (Group BF) received 25 μg (0.5 ml) of fentanyl with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine. Patients were assessed for hemodynamic changes, sensory and motor block, early postoperative analgesia, and adverse effects.
Onset, duration of sensory and motor block, and duration of effective analgesia were comparable between both groups. Postoperative visual analog scale score was 4.8 ± 1.12 in Group BN, and in Group BF, it was 3.86 ± 1.04 which was statistically highly significant ( = 0.0007). The number of patients demanding rescue analgesia in early postoperative period was 18 (60.0%) in Group BN and 7 (23.33%) in Group BF which was statistically significant ( = 0.004).
Fentanyl was more efficient than nalbuphine in providing early postoperative analgesia when used as an adjuvant to hyperbaric bupivacaine.
阿片类药物一直是脊髓麻醉期间局部麻醉药的常用辅助药物。纳布啡是一种μ受体拮抗剂和κ受体激动剂，似乎是局部麻醉药的合适辅助药物。本研究的目的是比较纳布啡和芬太尼在脊髓麻醉期间作为高压布比卡因辅助药物时的术后镇痛效果和不良反应。
60例美国麻醉医师协会身体状况I级和II级的患者被随机分为两组，每组30例。布比卡因-纳布啡组（BN组）患者接受0.8mg（0.3ml）纳布啡与12.5mg（2.5ml）0.5%高压布比卡因稀释至3ml，布比卡因-芬太尼组（BF组）患者接受25μg（0.5ml）芬太尼与12.5mg（2.5ml）0.5%高压布比卡因。评估患者的血流动力学变化、感觉和运动阻滞、术后早期镇痛及不良反应。
两组间感觉和运动阻滞的起效时间、持续时间以及有效镇痛时间相当。BN组术后视觉模拟评分（VAS）为4.8±1.12，BF组为3.86±1.04，差异具有高度统计学意义（P = 0.0007）。术后早期需要补救镇痛的患者数量，BN组为18例（60.0%），BF组为7例（23.33%），差异具有统计学意义（P = 0.004）。
当作为高压布比卡因的辅助药物时，芬太尼在提供术后早期镇痛方面比纳布啡更有效。
