European Journal of Molecular & Clinical Medicine

Background & Objective - This study aimed to compare efficacy of nalbuphine and fentanyl as adjuvant to bupivacaine in providing intra-operative anesthesia and post-operative analgesia in lower limb orthopedic surgeries, and to compare the characteristic of sensory and motor block, hemodynamic parameter, time of first rescue analgesia and adverse effects between two groups.
Method- In this clinical trial, 80 patients undergoing elective lower limb orthopedic surgeries under spinal anesthesia were randomly allocated in two groups. In group BN, the patients received 0.5% 3ml (Heavy Bupivacaine + 800 mcg Nalbuphine. In group BF patients received 0.5% 3ml (Heavy Bupivacaine + 25mcg Fentanyl.
Result & interpretation- The Onset of motor block, maximum level of block and time to reach peak level of block was significantly faster in group BF.While duration of motor block and time for first rescue analgesia was significantly prolonged in BN group. However, there was no significant difference in time for two segment regression=0.157 (NS) and hemodynamic changes.
Conclusion- We conclude that combination of fentanyl as adjuvant to bupivacaine provides higher segmental level sensory blockage, faster sensory and motor blockage than nalbuphine. But nalbuphine gives longer time of post-operative analgesia than fentanyl.

Background: In lower limb orthopedic surgeries there is significant postoperative pain, which is difficult to treat with oral or intravenous analgesics resulting in adverse endocrine, metabolic and inflammatory responses. Morphine, Pethidine, Fentanyl, and other opioids fall under the Narcotics Act whereas nalbuphine does not. So, the accessibility of Nalbuphine is not as major a concern in several hospitals in India as that of morphine and other such opioids. Present study was aimed to compare the effectiveness of 0.8mg nalbuphine with 20 mcg fentanyl as an adjuvant to hyperbaric bupivacaine in lower limb orthopedic surgeries. Material and Methods: Present study was single-center, prospective, comparative study, conducted in patients of either gender, age group of 18-60 years, belonging to ASA CLASS 1 and 2, With BMI < 30, undergoing elective orthopedic lower limb surgery. Patients were allocated in Group N- Received intrathecal 0.8 mg Nalbuphine & 3 ml 0.5 % H bupivacaine & Group F- Received intrathecal 20 mcg Fentanyl & 3 ml 0.5 % H bupivacaine.

Background: Monitored Anaesthesia Care (MAC) typically involves administration of local anaesthesia in combination with IV sedatives, anxiolytic and/or analgesic drugs.  Present study was aimed to compare middle ear surgeries under sedation and local anaesthesia with midazolam plus dexmed versus midazolam plus nalbuphine.
Material and Methods: Present study was a prospective, comparative study conducted in patients 18-60 years age, either gender, ASA Grade I /II, posted for middle ear surgery under Sedation & local anaesthesia. In first group MD, patients received intravenous inj. midazolam 1 mg plus inj. dexmedetomidine 1 ugm /kg bolus and 0.5 ugm kg added in 100 ml NS infusion, given at 0.3 to 0.4 ugm/ min. In second group MN, patients received intravenous inj. midazolam 1 mg plus inj nacphin 10 mg slowly.
Results: Patients were randomly divided in two groups of 30 each. In present study, age, gender, BMI, ASA grade, type of surgeries (Tympanoplasty, mastoidectomy, stapedectomy) & duration of surgery was comparable & difference was not statistically significant. Ramsay Sedation Score (RSS) at 30,40 & 90 minutes was better in MD group as compared to MN group, difference was statistically significant. Visual Analogue Score (VAS) at 20, 30,40, 60 & 90 minutes was better in MD group as compared to MN group, difference was statistically significant. Patient & Surgeon satisfaction score was better in group MD as compared to group MN, but difference was not statistically significant. Conclusion: Dexmedetomidine with midazolam was better than nalbuphine with midazolam, with respect to sedation, analgesic effect, patient & surgeon satisfaction.

Aim: The purpose of the present study was to assess the comparison between midazolam-nalbuphine and midazolam-fentanyl combinations for analgesic as well as sedative effect in patients who have undergone fibre-optic intubation in awake state.
Methodology: 100 patients between the age of 20 and 60 yrs of either sex, scheduled for elective surgery were included after taking written informed consent. Premedication with Inj. Glycopyrrolate 0.2 mg i.m. 30 mins before and Inj. Midazolam 1 mg i.v. 15 mins before the procedure was given. Then patients were randomly divided into 2 groups. Group N (n=30) received inj. nalbuphine 0.2 mg/kg i.v. and group B (n=30) received inj. fentanyl 2 mcg/kg i.v., both 5 mins prior to the introduction of fiberscope. The nasotracheal fiberoptic intubation was carried out using spray as you go technique. Level of sedation, intubation score and VAS score were observed along with patient comfort score
Results: Group F patients had better sedation score (P=0.328), VAS score (P=0.184), significantly better intubation score (P=0.00), intubation time (0.00) and patient comfort score (P=0.05). Hemodynamics (heart rate, systolic blood pressure, diastolic blood pressure) were significantly better in group F.
Conclusion: Fentanyl-midazolam combination for awake fibreoptic intubation using spray as you go technique, provided better sedation and analgesia, obtunded airway reflexes and minimized pressor response to awake fibreoptic intubation and provided better patient comfort.

Aim: The purpose of this study is to analyze and compare the properties of
Dexmedetomidine with that of Nalbuphine regarding duration of sedation, recovery and
adverse effects in short surgical procedures.
Materials and methods: It is observational clinical study involving 60 patients belonging to
ASA grade 1 & 2 posted for elective minor surgical procedures lasting about 45 -60 minutes,
comparison between Dexmedetomidine and Nalbuphine was done and the onset of sedation,
duration of sedation and recovery from sedation including adverse effects of both drugs,
hemodynamic and respiratory parameters were evaluated. Patients were randomly divided
into 2 groups of 30 each .Group N( Nalbuphine) received 50 mcg /kg of Nalbuphine and
Group D(Dexmedetomidine) received 1 mcg/kg of Dexmedetomidine over 10 minutes .
Results: Demographic parameters in both groups were comparable (p>0.05).Nalbuphine and
Dexmedetomidine has comparable onset of time for sedation, duration of sedation and
recovery from the sedation. Onset of sedation is fast in Dexmedetomidine; total duration of
sedation is more with dexmedetomidine and has provided good sedation during the surgical
procedure. As reported in several studies dexmedetomidine offered good cardiovascular
stability without the risk of hypotension . No significant side effects were noted with
dexmedetomidine when compared with Nalbuphine.
Conclusions:Dexmedetomidine when used as a peri operative sedative agent has faster onset
of sedation ,longer duration of sedation ,and the recovery from sedation

Background: The process of Laryngoscopy & Intubation is a noxious stimulus, therefore constituting a period of intense sympathetic activity. Various non-pharmacological & pharmacological methods have been used to attenuate this hemodynamic response. Opioids are potent agents that can attenuate pressor response by maintaining the proper depth of anaesthesia. Although there are few studies comparing opioids in attenuating hemodynamic response during intubation, none of them incorporated measuring serum cortisol levels during intubation. Henceforth, in our study, we have compared the efficacy of bolus administration of intravenous (IV) fentanyl, IV morphine and IV nalbuphine to suppress the pressor response and serum cortisol level during laryngoscopy and endotracheal intubation.
Objectives:
1) To evaluate the efficacy of Intravenous (IV) opioids in attenuating the stress response and serum cortisol levels during endotracheal intubation.
Materials and Methods: In our study, 60 ASA I and II patients, aged between 20 to 60 years were enrolled and randomly divided into three groups. Of the three groups group I (received Fentanyl 2 mcg/kg), group II (Received Morphine 0.1mg/kg), and group III (received Nalbuphine 0.2mg/kg). Patients who are pregnant, lactating or illicitly abusing centrally acting drugs, or allergic to the drug under study are excluded from the study After random group allocation hemodynamic parameters like heart rate, blood pressure, and mean arterial pressure were monitored at baseline followed by a 1-minute interval up to 4 minutes after intubation. Furthermore, Blood sampling was done in the preoperative ward followed by a 5- and 10-minutes period after intubation intraoperatively for measuring serum cortisol levels. Conclusion: Comparatively, fentanyl caused a significant reduction in stress response during laryngoscopy and intubation followed by morphine and nalbuphine.

Background: Subarachnoid (spinal) block is a safe and effective alternative to general anesthesia for arthroscopic knee surgeries. Hyperbaric bupivacaine, the local anaesthetic most commonly used, don’t have the advantage of prolonged analgesia. Due to the early arising post-operative pain the role of various adjuvants has been proposed and evaluated. The present study was aimed to compare the clinical efficiency of intrathecal fentanyl with nalbuphine as adjuvant to 0.5% hyperbaric bupivacaine for arthroscopic knee surgeries. Patients and Methods: A total of 68 patients were randomly taken for this study and categorized into Group Ⅰ (nalbuphine) and Group II (fentanyl). Each group received 12.5mg of 0.5% heavy bupivacaine with 1 mg nalbuphine or 25μg fentanyl diluting it to 3 ml total volume. Sensory and motor block characteristics and time to first rescue analgesia were recorded as the primary end points. Drug‑related side effects of hypotension, bradycardia, respiratory depression, nausea, vomiting, shivering, urinary retention and pruritus were recorded as the secondary outcomes.
Results: Sensory and motor blockade and time for peak sensory level was earlier in group I as compared to group II. Mean time for 2 segments regression in Group I was prolonged as compared to group Ⅱ. Duration of motor block in Group I [241.471± 12.464 min]was significantly prolonged compared to Group II [179.265± 6.868 min] with (p=0.000). Sensory level at L4 in Group I was 406.618± 17.953 min and in Group II was 228.235± 8.694 min with (p=0.000). Rescue analgesia time in Group I [401.471±16.946 min] was significantly prolonged as compared to Group II [220.000±11.282 min] with (p=0.000). The adverse events in group I are lesser as compared to group II and was statistically significant.
Conclusion: Nalbuphine is a better adjuvant than fentanyl in spinal anesthesia for prolonging post-operative analgesia.