Morphine with Nalbuphine as an Adjuvant to Caudal Bupivacaine: A Double blinded Randomized Study

What is it about?

Morphine with Nalbuphine as an Adjuvant to Caudal Bupivacaine: A Double blinded Randomized Study

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Photo by Rook of Arts on Unsplash

Photo by Rook of Arts on Unsplash

Why is it important?

Context: Caudal analgesia is the most preferred technique for pain relief in paediatric population using local anaesthetic drug along with other adjuvants such as morphine, fentanyl, nalbuphine, tramadol, clonidine. Aim: To compare the efficacy and assess the complications of morphine and nalbuphine as an adjuvant to caudal bupivacaine for postoperative analgesia. Settings and Design: It is a prospective randomized double blind control study , conducted in Melmaruvathur Adhiparasakthi Institute of Medical Sciences & Research over a period of six months from August 2017 to January 2018 after getting ethical approval. Methods and Material: Children fulfilling the inclusion criteria were randomly allocated to receive 1ml/kg of caudal bupivacaine 0.25% either with morphine 50ug/kg (group M ) or nalbuphine 0.2 mg/kg (group N) following general anaesthesia. Post operative pain scores assessed using FLACC score and sedation using Modified Wilson scoring. Complications such as respiratory depression, vomiting, & pruritis were also noted. Statistical analysis used: Statistical analysis was performed using appropriate test with Graphic prism 5.0 software. Results: Two groups are comparable in age, sex & weight. The post operative pain scores were less in group M compared to group N and they are statistically significant (p<0.05) only at 0 (0.500±0.124 vs 0.866±0.114), 1 (0.667±0.66 vs 1.200±0.78) & 2 (1.400±0.498 vs 2.000±0.830) hours but they were not statistically significant at 4 (2.133±0.776 vs 2.567±1.006), 8 (3.400±0.959vs 4.200±1.003), & 12 hours (5.733±0.827 vs 6.500±1.841). Requirement of rescue analgesic were significantly longer in group M (11.93±1.98 hrs) compared to group N (9.150±1.29) and they are statistically significant (p< 0.05). Post operative sedation score are statistically significant between two groups. Conclusions: As an adjuvant to bupivacaine ,morphine has prolonged the duration of analgesia and decreased the use of rescue analgesic for around 12 hours but at this therapeutic dose, it is associated with higher life threatening complications such as respiratory depression, and other complications like nausea and vomiting whereas Nalbuphine has decreased the use of rescue analgesic for more than 8 hours and has not produced above mentioned complication . Hence the usage of morphine as an adjuvant can be replaced with nalbuphine in Pediatric surgeries.

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