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ORIGINAL ARTICLE
Year : 2020  |  Volume : 4  |  Issue : 2  |  Page : 153-158

Nalbuphine versus neostigmine as an adjuvant to intrathecal hyperbaric bupivacaine-induced postoperative analgesia


1 Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt
2 Department of General Surgery, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt

Correspondence Address:
MD Enas M Ashrey
Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine for Girls, Al Azhar University, Alzahraa University Hospital Abbasia, Cairo, 11517
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjamf.sjamf_16_20

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Introduction Pain remains one of the most important patient complaints after hemorrhoid surgery; most anal surgical procedures are done as a day-case procedure, so medication to relieve or stop pain and provide analgesia should be administered preoperatively to provide postoperative analgesia. Aim The aim of the study is to evaluate the effect of nalbuphine versus neostigmine as an adjuvant to intrathecal hyperbaric bupivacaine on duration of motor block and postoperative analgesia. Patients and methods A total of 40 adult patients of both sexes, with American Society of Anesthetists status I–II, aged between 21 and 60 years, enlisted to undergo hemorrhoidectomy under spinal anesthesia were included. Patients were randomly divided into two groups. Group I was the nalbuphine group (n=20), which received 15 mg (3 ml) of 0.5% hyperbaric bupivacaine+2 mg (0.1 ml) of nalbuphine HCl. Group II was the neostigmine group (n=20), which received 15 mg (3 ml) of 0.5% hyperbaric bupivacaine+50 μg (0.1 ml) of neostigmine. The total volume administered in each group was 3.1 ml. Results The onset of sensory block was significantly faster in nalbuphine group than neostigmine group, whereas onset of motor block was significant faster in neostigmine group than in nalbuphine group (P=0.0001). The time to two-segment sensory regression was significantly longer in nalbuphine group than in neostigmine group (P<0.0001). Duration of motor block was significantly prolonged in nalbuphine group compared with neostigmine group (P<0.0001). Postoperative visual analog scale was significantly less in nalbuphine group than in neostigmine group. Duration of postoperative analgesia was highly significantly longer in nalbuphine group than neostigmine group (P<0.0001). Postoperative total analgesic consumption in 24 h was less in nalbuphine group than in neostigmine group (P≤0.0001), with no significant adverse effect. Conclusion Addition of either nalbuphine or neostigmine to intrathecal hyperbaric bupivacaine induces postoperative analgesia with no significant adverse effect. However, nalbuphine was superior to neostigmine in prolongation of duration of motor block and postoperative analgesia, with decreased postoperative analgesic requirement.


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