Role of nalbuphine as an adjuvant to ropivacaine in supraclavicular block- a randomized control study

Abstract

Background: Nalbuphine is a strong analgesic with mixed k agonist and μ antagonist was studied several times as adjuvant to local anesthetics in spinal, epidural and local infiltration but very few studies on brachial plexus block. The aim of this study was to evaluate the effect of nalbuphine as an adjuvant to ropivacaine 0.75% in supraclavicular brachial plexus block.
Methodology: In a prospective, double blind study of sixty patients undergoing elective upper limb surgeries were randomized into two groups. Group R - (n = 30), 29 mL of 0.75% ropivacaine + 1 mL normal saline and in study Group N (n = 30), 29 mL of 0.75% ropivacaine + 1 mL (10 mg) nalbuphine were used for giving supraclavicular block under Ultrasound (US) guidance. Parameters assessed were onset and duration of sensory and motor block, duration of analgesia, and any adverse events. After administration of block with above drugs, the block characteristics were assessed every 2 and 3 min till onset of complete blockade, then hourly till the effect of block persist. Data between the groups were analyzed using independent ttest with statistical package for social science (SPSS) 21.0 software.
Results: The demographic profile of the patients age, sex, weight, ASA grade were comparable in both groups. There were no hemodynamic variations and no complication of technique or adverse effects due to nalbuphine occurred (p ˃ 0.05). The mean onset times of sensory blocks was 11.58 ± 3.56 vs. 10.84 ± 3.24 (p = 0.40) and onset times of motor block was 13.12 ± 4.98 vs. 11.23 ± 3.29 (p = 0.09) in Group R and Group N respectively. The differences were not statistically significant in both groups. The mean duration of sensory block [e.g. 512.52 ± 16.47 vs. 588.25 ± 19.63 min (p = 0.0001)] and motor block [467.66 ± 17.34 vs. 518.45 ± 16.65 min (p = 0.0001)] were significantly prolonged in Group R than in Group N. The mean duration of analgesia was significantly more in Group R than in Group N, e.g. 598.21 ± 19.33 vs. 705.39 ± 31.54 min (p < 0.0001)
Conclusion: Nalbuphine significantly extends the duration of analgesia of brachial plexus block under supraclavicular approach when used with 0.75% ropivacaine and has no adverse effects.
Citation: Yadav VK, Choudhary AK, Prasad MK, Jheetay GS, Kumar A, Shahid R. Role of nalbuphine as an adjuvant to ropivacaine in supraclavicular block- a randomized control study. Anaesth. pain & intensive care 2019;23(2):186-191