Effect of Nalbuphine as Adjuvant to Bupivacaine for Ultrasound-Guided Popliteal Nerve Block

What is it about?

Effect of Nalbuphine as Adjuvant to Bupivacaine for Ultrasound-Guided Popliteal Nerve Block

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Photo by Daiga Ellaby on Unsplash

Photo by Daiga Ellaby on Unsplash

Why is it important?

Introduction: Popliteal nerve block is a useful technique for ankle and foot surgeries as it avoids complications in elderly who are prone for hemodynamic changes leading to increased morbidity and mortality. There is advantage of early post operative mobility which is essential in orthopaedic surgeries and absence of post dural puncture headache. Nalbuphine is a derivative of 14-hydroxymorphine which is a strong analgesic with mixed k agonist and μ antagonist action.The primary aim of study is to evaluate effect of adding Nalbuphine to Bupivacaine in popliteal nerve block in terms of onset and duration of sensory and motor blockade and duration of analgesia. Study Design: A prospective randomised comparative clinical study. Materials and Methods: After obtaining institutional ethical committee clearance. Sixty patients between 18 -70 years of either sex with ASA status I, II, III posted for ankle and foot surgeries were grouped randomly into two groups using simple sealed envelope method with 30 in each group. After getting informed consent from patients detailed pre anaesthetic evaluation was done on previous day of surgery. Group A received 20ml of Bupivacaine with 1ml of normal saline and group BN received 20ml of Bupivacaine with 1ml of 10mg Nalbuphine. Data presented as mean and standard deviation. The t-test was used to examine the differences between means. Statistical significance was accepted for a p < 0.05. Results: Sensory blockade: In our study we found that Group BN patients who received Nalbuphine as additive provided faster onset of sensory level blockage with mean time of onset value being 11.8 ± 2.4 (in mins) compared to Group A where mean value was 15.20 ± 1.80 (in mins) . The results were statistically signicant with a p value of <0.001**. The duration of sensory level block in Group BN who received Nalbuphine as additive was 760 ± 23.3 compared to Group A where mean value was 552 ± 19 with statistically signicant p value of <0.001**. Motor blockade: In our study we found that Group BN patients who received Nalbuphine as additive provided faster onset of motor level blockage with mean time of onset value being 14.7 ± 1.5 (in mins) compared to Group A where mean value was17.6 ± 1.1(in mins) . The results were statistically signicant with a p value of <0.001**. The duration of motor level block in Group BN was 573 ± 20.6 compared to Group A where mean value was 438 ± 18.4 with statistically signicant p value of <0.001**. Conclusion: This study demonstrates that addition of 10 mg nalbuphine to bupivacaine in popliteal nerve block in patients undergoing ankle and foot surgeries decreases time of onset of anaesthesia, shows signicant increase in duration of sensory and motor blockade and also increases the post operative analgesia.

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