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Intravenous Sedation for Tympanoplasty – Comparison of I.V. Dexmedetomidine and Nalbuphine with I.V.

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Introduction: Monitored Anaesthesia Care (MAC) involves administration of local anaesthesia (LA) with intravenous sedatives, anxiolytic and analgesic drugs with detailed monitoring of vital parameters. In tympanoplasty, reconstruction of tympanic membrane with or without ossicular reconstruction is done. To avoid pain, decrease bleeding IV sedation with local anaesthesia is preferred. In this study we compared the effects of Inj. Dexmedetomidine and Inj. Nalbuphine versus Inj. Dexmedetomidine and Inj. Fentanyl. Aims and objectives: 1. To compare the sedation effects and analgesic effects of Dexmedetomidine (1mcg/kg) / Nalbuphine (100 mcg/kg) and Dexmedetomidine (1mcg/kg) /Fentanyl (1mcg/kg) in I.V. sedation in Tympanoplasty. 2. To compare Heart rate, Systolic Blood Pressure, Diastolic Blood Pressure, Mean Arterial Pressure, Respiratory Rate, Oxygen Saturation (SpO2) and Surgeon’s Satisfaction Score. Material and method: 60 patients undergoing tympanoplasty surgery under MAC were randomly divided in two groups of 30 each according to chit block method in addition toInj. Dexmedetomidine 1µgm/kg received either inj. Nalbuphine 100µgm/kg (Group N) or inj. Fentanyl 1µgm/kg (Group F) intravenously for sedation along with local anaesthesia during surgery. Ramsay sedation score (RSS), Visual analogue score (VAS), Heart rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean arterial pressure (MAP), Respiratory Rate (RR), Oxygen Saturation (SpO2) were recorded after giving both the drugs at the interval of 2, 4, 6, 8, 10, 30, 60, 90, 120 minutes. Result: We observed that RSS score was more and VAS score was less in group N than group F. This indicates that sedation and analgesia was better in Dexmedetomidine with Nalbuphine group than Dexmedetomidine with Fentanyl group. Decrease in heart rate, Systolic Blood Pressure and Diastolic Blood Pressure, Mean Arterial Pressure was statistically significant in group N than group F. This indicates that Dexmedetomidine with Nalbuphine provides better cardiovascular stability. Rescue analgesic requirement was comparable in both groups. Conclusion: From this study, we concluded that, intravenous Inj.Dexmedetomidine with Inj. Nalbuphine provides better sedation and analgesia, good hemodynamic stability, good surgeon’s satisfaction score without side effects. It also reduces the requirement of rescue sedation and analgesia as compared to Inj.Dexmedetomidine with Inj.Fentanyl in patients undergoing Tympanoplasty under local anaesthesia with monitored anaesthesia care. Thus Dexmedetomidine with Nalbuphine is a better alternative to Dexmedetomidine with Fentanyl as sedation for middle ear surgery.

Perspectives

Introduction: Monitored Anaesthesia Care (MAC) involves administration of local anaesthesia (LA) with intravenous sedatives, anxiolytic and analgesic drugs with detailed monitoring of vital parameters. In tympanoplasty, reconstruction of tympanic membrane with or without ossicular reconstruction is done. To avoid pain, decrease bleeding IV sedation with local anaesthesia is preferred. In this study we compared the effects of Inj. Dexmedetomidine and Inj. Nalbuphine versus Inj. Dexmedetomidine and Inj. Fentanyl. Aims and objectives: 1. To compare the sedation effects and analgesic effects of Dexmedetomidine (1mcg/kg) / Nalbuphine (100 mcg/kg) and Dexmedetomidine (1mcg/kg) /Fentanyl (1mcg/kg) in I.V. sedation in Tympanoplasty. 2. To compare Heart rate, Systolic Blood Pressure, Diastolic Blood Pressure, Mean Arterial Pressure, Respiratory Rate, Oxygen Saturation (SpO2) and Surgeon’s Satisfaction Score. Material and method: 60 patients undergoing tympanoplasty surgery under MAC were randomly divided in two groups of 30 each according to chit block method in addition toInj. Dexmedetomidine 1µgm/kg received either inj. Nalbuphine 100µgm/kg (Group N) or inj. Fentanyl 1µgm/kg (Group F) intravenously for sedation along with local anaesthesia during surgery. Ramsay sedation score (RSS), Visual analogue score (VAS), Heart rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean arterial pressure (MAP), Respiratory Rate (RR), Oxygen Saturation (SpO2) were recorded after giving both the drugs at the interval of 2, 4, 6, 8, 10, 30, 60, 90, 120 minutes. Result: We observed that RSS score was more and VAS score was less in group N than group F. This indicates that sedation and analgesia was better in Dexmedetomidine with Nalbuphine group than Dexmedetomidine with Fentanyl group. Decrease in heart rate, Systolic Blood Pressure and Diastolic Blood Pressure, Mean Arterial Pressure was statistically significant in group N than group F. This indicates that Dexmedetomidine with Nalbuphine provides better cardiovascular stability. Rescue analgesic requirement was comparable in both groups. Conclusion: From this study, we concluded that, intravenous Inj.Dexmedetomidine with Inj. Nalbuphine provides better sedation and analgesia, good hemodynamic stability, good surgeon’s satisfaction score without side effects. It also reduces the requirement of rescue sedation and analgesia as compared to Inj.Dexmedetomidine with Inj.Fentanyl in patients undergoing Tympanoplasty under local anaesthesia with monitored anaesthesia care. Thus Dexmedetomidine with Nalbuphine is a better alternative to Dexmedetomidine with Fentanyl as sedation for middle ear surgery.

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This page is a summary of: Intravenous Sedation for Tympanoplasty – Comparison of I.V. Dexmedetomidine and Nalbuphine with I.V. Dexmedetomidine and Fentanyl, Indian Journal of Anaesthesia and Analgesia, January 2018, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.51118.3.
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