An Observational study of comparison of Isobaric Ropivacaine 0.75% and Isobaric Ropivacaine 0.75% with Nalbuphine intrathecally in infra-umbilical surgeries

Abstract

Introduction: Spinal anaesthesia is preferred for infraumbilical and lower limb surgeries. Ropivacaine is a suitable and safe choice for local anesthesia during subarachnoid block that results in a shorter period of motor block and less risk of neuro-cardiotoxicity. Nalbuphine has gained popularity due to its ability to reduce μ-opioid activity and increase k-opioid activity.

Objective: To evaluate the effect of addition of nalbuphine 1 mg to isobaric ropivacaine 0.75% on onset and duration of sensory and motor blockade, hemodynamic stability, duration of postoperative analgesia and complications in patients undergoing infra-umbilical surgeries

Materials and Methods: A comparative observational study was conducted among 40 patients undergoing perianal surgeries. They were grouped into Group-R & Group-RN with 20 patients in each. Group R patients received Isobaric Inj.Ropivacaine 0.75% 3.5 ml with 0.5 ml Sterile NS. Group RN patients received Isobaric Inj.Ropivacaine 0.75% 3.5 ml +1 mg Inj. Nalbuphine (0.1 ml) diluted till 0.5 ml with sterile NS. Spinal Anaesthesia was given as per protocol under aseptic precautions. Sensory and motor analgesia was noted as per the pin prick method and Bromage grade, respectively. Intraoperative assessment and management of adverse events were performed where required. Duration of anaesthesia and unassisted ambulation was noted.

Results: The mean time for onset of Sensory block at T12 was (5.65 ± 0.5; 4.8 ± 0.7 min)in Group R and RN respectively. The mean time for the onset of motor block was (5.95 ± 0.7; 4.5 ± 0.5 min)in Group R and RN. The mean two-segment regression time was (142.6 ± 11.4; 161.0 ± 2.6  min) in Group R and RN.The mean duration of sensory block was (195.25 ± 9.4; 342.7 ± 22.9 min) in Group R and RN. The mean duration of motor block was (192.1 ± 9.4; 267.7 ± 18.8 min)in Group R and RN. The mean duration of analgesia was (242.6 ± 7; 443.0 ± 30.6  min) in Group R and RN.

Conclusion: The onset of sensory and motor block was significantly faster in Ropivacaine with nalbuphine group as compared to Ropivacaine. The mean duration of analgesia, sensory and motor block was significantly longer in Ropivacaine with nalbuphine as compared to Ropivacaine.