Comparison of Morphine with Nalbuphine as an Adjuvant to Caudal Bupivacaine: A Double blinded Randomized Study
Journal Title: Indian Journal of Anesthesia and Analgesia - Year 2018, Vol 5, Issue 7
Abstract
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.
Authors and Affiliations
Prasath Chandran
Keywords
Related Articles
- EP ID EP535152
- DOI 10.21088/ijaa.2349.8471.5718.13
- Views 98
- Downloads 0
Comparison of Ondensetron & Dexamethasone Alone and Combination as Prophylaxis in Post Operative Laparoscopic Surgeries
Background: Post-operative nausea and vomiting is very much prevalent and unpleasant complaints with laparoscopic surgeries that leads to numerous emergencies so antiemetic prophylaxis reduced complications associated wi...
Real-time Ultrasound-Guided Catheterization of the Internal Jugular Vein: A Prospective Comparison with the Landmark Technique
Introduction: Conventionally central venous catheter is done utilising landmark technique. With increased availability of portable USG units, USG-guided intervention is fast gaining acceptance as a valuable tool in the c...
A Comparison of Ultrasound Guided Versus Ultrasound with Nerve Stimulation Technique for Obturator Nerve Block in Transurethral Resection of Bladder Tumour
Introduction: The aim of the study was to compare the effectiveness of two different techniques in blocking obturator nerve (ON) and adductor spasm during transurethral resection of bladder tumor (TURBT). Methodology: W...
Comparison of Effects of Intrathecal Fentanyl versus Dexmedetomidine in Patients undergoing Transurethral Resection of Prostate
Objectives: Comparison of block characteristics and postoperative analgesic efficacy of Fentanyl and Dexmedetomidine, as a adjuvant to intrathecal hyperbaric 0.5% Bupivacaine for patients undergoing Transurethral resecti...
Comparison of the Efficacy of Classic LMA (CLMA) and Proseal LMA (PLMA) in Paralysed, Anesthetized Patients
Context: Laryngeal mask airway (LMA) has revolutionized airway management in the administration of general anesthesia. Proseal LMA offers advantages like better sealing pressure, drain tube and lesser risk of aspiration....