Nalbuphine bests fentanyl as intrathecal additives for postoperative analgesia in infraumbilical surgeries: Study

Recently published study compared the efficacy of nalbuphine and fentanyl as intrathecal additives alongside local anesthetic for postoperative analgesia in infraumbilical surgeries. A total of 166 patients were included in the double-blind randomized controlled trial, with Group N receiving 2.5 mL of 0.5% bupivacaine + 1 mg of nalbuphine and Group F receiving 2.5 mL of 0.5% bupivacaine + 25 mcg fentanyl. The study compared parameters such as onset and duration of sensory and motor blockade, intraoperative hemodynamics, and side effects. Results showed that nalbuphine provided a longer duration of analgesia (267.27 ± 172.099 minutes in Group N vs. 161.35 ± 14.957 minutes in Group F) with better hemodynamic stability.

Importance of Spinal Anesthesia and Adjuvants

The study highlighted the importance of spinal anesthesia for infraumbilical surgeries and emphasized the need for adjuvants to prolong postoperative analgesia. It discussed the use of conventional and newer local anesthetic agents and the challenge of maximizing the duration of analgesia in the postoperative period. The study focused on the use of nalbuphine and fentanyl as intrathecal adjuvants and their effects on postoperative analgesia, sensory and motor blockade, and hemodynamic parameters.

The findings revealed that nalbuphine as an intrathecal additive along with local anesthetic provided a more prolonged duration of postoperative analgesia compared to fentanyl, and it offered better hemodynamic stability. The study discussed the dosage, administration, and safety profile of nalbuphine, and highlighted that the findings were in line with previous studies. It also acknowledged limitations such as the lack of intragroup analyses on the type of surgery's effects on hemodynamic parameters and the optimal dose of nalbuphine. Finally, the study concluded that intrathecal nalbuphine was found to be more safe and effective than intrathecal fentanyl for postoperative analgesia in infraumbilical surgeries.

Key Points

- The study compared the efficacy of nalbuphine and fentanyl as intrathecal additives alongside local anesthetic for postoperative analgesia in infraumbilical surgeries. It involved a double-blind randomized controlled trial with 166 patients, where Group N received nalbuphine and Group F received fentanyl, and compared parameters such as onset and duration of sensory and motor blockade, intraoperative hemodynamics, and side effects.

- Nalbuphine provided a longer duration of analgesia with better hemodynamic stability compared to fentanyl. The duration of postoperative analgesia was 267.27 ± 172.099 minutes in Group N vs. 161.35 ± 14.957 minutes in Group F.

- The study highlighted the importance of spinal anesthesia for infraumbilical surgeries and the need for adjuvants to prolong postoperative analgesia. It also concluded that intrathecal nalbuphine was found to be more safe and effective than intrathecal fentanyl for postoperative analgesia in infraumbilical surgeries.

References –

Jananimadi S, Arish B, Hariharasudhan B, et al. (April 17, 2024) Comparison of Postoperative Analgesia Between Intrathecal Nalbuphine and Intrathecal Fentanyl in Infraumbilical Surgeries: A Double-Blind Randomized Controlled Trial. Cureus 16(4): e58503. DOI 10.7759/cureus.58503