A comparative study of nalbuphine, fentanyl and pentazocine as intravenous analgesics for postoperative pain relief in minor general surgical procedures

Priyanka Bhot, Preeti more, Damayanti Shah

Abstract


Background and aims: Postoperative pain is acute pain and can affect nearly every organ function and may adversely influence postoperative morbidity and mortality. Pharmacological management with intravenous opioids is a common, effective and   a well known method used to treat this pain. Our study aims at comparing the analgesic efficacy of nalbuphine, fentany and pentazocine as opioid analgesics for post operative pain relief in minor general surgical procedures Methods: In this prospective, double blind, randomized controlled clinical trial, 90 patients aged 18 to 60 years, ASA grade 1 or 2, posted for minor general surgery procedures, lasting less than 1 hour under general anaesthesia. Study design: Patients were randomly allocated into 3 groups, Group I (Nalbuphine) received 0.2 mg/kg of Nalbuphine hydrochloride, Group II (Fentanyl) received 2 mcg/kg Fentanyl and Group III (Pentazocine) received 0.6 mg/kg Pentazocine, intravenously prior to induction of anaesthesia.  Hemodynamic parameters, postoperative analgesia, time of rescue analgesia, respiratory depression, sedation scores and side effects were studied. Results: Pain assessed as VAS scores were not significantly different to start with (60 mins) immediate postop in all 3 groups (p= 0.84).They were lower in Group I (nalbuphine) at 120,180 and 240 mins. At 360 mins, there was no significant difference between the mean VAS across all the groups. This suggests that all three opioids, nalbuphine, fentanyl and pentazocine provide good postoperative analgesia till 240 mins (4hrs) however nalbuphine has added effect and advantage as seen from the lesser VAS and provides longer duration of analgesia. No significant differences were seen in recovery from anaesthesia. No significant side effects of nausea, vomiting, excessive sedation and respiratory depression were noted in all the 3 groups

Conclusion: Nalbuphine, a synthetic opioid agonist- antagonist provides good postoperative analgesia in minor general surgical patients as compared to fentanyl and pentazocine , hence useful in day care surgeries.

Keywords


postoperative analgesia, day care surgeries, nalbuphine, fentanyl, pentazocine

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References


Barash PG, Cullen BF, Stoelting RK. Clinical anaesthesia. 5th ed. Philadelphia (USA): Lippincott Williams and Wilkins; 2006. 1405-1419.

Stoelting R K, Hiller S C. Pharmacology in anesthesia.5th ed. Philadelphia (USA).Lippincott Williams and Wilkins; 2006. 87-119

Bailey LP, Pace NL, Aschburn MA, Moll JWB, East KA, Stanley TH: Frequent hypoxemia and apnea after sedation with midazolam and fentanyl. Anesthesiology 1990; 73: 826-830.

Panjabi G M, Tank PR. A comparative study of nalbuphine and fentanyl for post operative pain relief in patient undergoing short surgical procedures. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) 2015; 14(10) :15-18

Dilip Kothari and Chetan K. Sharma. Effect of nalbuphine and pentazocine on attenuation of hemodynamic changes during laryngoscopy and endotracheal intubation: A clinical study. Anesth Essays Res. 2013; 7(3): 326–330.

Claxton A R,McGuire G,Chung F,Cruise C. Anesthesia and Analgesia 1997; 84:509-14.

A van den Berg, N M Honjol, N V Prabhu, S Datta, C J Rozario, R Muraleedaran, and D Savva. Analgesics and ENT surgery. A clinical comparison of the intraoperative, recovery and postoperative effects of buprenorphine, diclofenac, fentanyl, morphine, nalbuphine, pethidine and placebo given intravenously with induction of anaesthesia. Br J Clin Pharmacol. 1994; 38(6): 533–543.

Ahsan-ul-Haq, M. Kazmi EH, Rao ZA. Nalbuphine prevents haemodynamic response to endotracheal intubation. J Coll Physicians Surg Pak. 2005;15: 668–70.

Lefevre B, Freysz M, Lepine J, Royer JM, Perrin D, Malka G. Comparison of nalbuphine and fentanyl as intravenous analgesics for medically compromised patients undergoing oral surgery. 1993, Anesth Prog. 1993, 39(1-2):13-8.

Nonaka A, Suzuki S, Abe F, Masui K. Comparison of pentazocine and fentanyl in total intravenous anesthesia using propofol. Masui 2006; 55(8): 983-7.

Miller RR. Evaluation of nalbuphine hydrochloride. Am J Hosp Pharm. 1980 Jul; 37 (7):942-9.

Siddiqui KM, Chohan U. Tramadol versus Nalbuphine in total intravenous anaesthesia for Dilatation and Evacuation. JPMA 2007;57:67

Minai FN, Khan FA. A comparison of morphine and nalbuphine for intraoperative and postoperative analgesia. J Pak Med Assoc. 2003; 53(9):391-6

Zhang XiuYan; Li MingRui; Zhan Hong; Huang LiFang. Comparison of the effect of pentazocine and fentanyl for patient-controlled intravenous analgesia in patients undergoing gynecological laparoscopic surgery. Journal of Tropical Medicine (Guangzhou) 2009; (9): (7) 766-768.

T. Tammisto, I. Tigerstedt. Comparison of the Analgesic Effects of Intravenous Nalbuphine and Pentazocine in Patients with Postoperative Pain. Acta Anaesthesiologica Scandinavica 1977(21),(5) 390-94,

Bone ME, Dowson S, Smith G. A comparison of nalbuphine with fentanyl for postoperative pain relief following termination of pregnancy under day care anaesthesia. Anaesthesia.1988; 43 (3):194-7.

Donadoni R, Rolly G, Devulder J, Verdonck R. Double-blind comparison between nalbuphine and pentazocine in the control of postoperative pain after orthopedic surgery.Acta Anaesthesiol Belg. 1988; 39(4):251-6.

Khan FA, Hameedullah .Comparison of fentanyl and nalbuphine in total intravenous anaesthesia (TIVA). J Pak Med Assoc 2002; 52(10):459-65.

Sharma K, Audichya P C, Goyal S, Soni K, Petkar J. Randomized Comparison Of Tramadol, Nalbuphine And Fentanyl Used As Premedication In Attenuation Of Hemodynamic Response To Laryngoscopy And Postoperative Pain In Laparoscopic Cholecystecyomy. IJMSCI 2016 ; 3 (7 ) 1968-76

Garfield JM, Garfield FB, Philip BK, Earls F, Roaf E. A comparison of clinical and psychological effects of fentanyl and nalbuphine in ambulatory gynecologic patients. Anesth Analg.1987; 66(12):1303-7.

Crul JF, Smets MJ, van Egmond J. The efficacy and safety of nalbuphine in balanced anesthesia. A double blind comparison with fentanyl in gynecological and urological surgery. Acta Anaesthesiol Belg. 1990; 41(3): 261-7.


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