A randomized controlled parallel study of nalbuphine and fentanyl on hemodynamic response to laryngoscopic and laparoscopic stress in patients undergoing laparoscopic appendectomy under general anaesthesia

Aims: Hemodynamic changes caused by laryngoscopy, endotrachial intubation and creation of pneumoperitonium in laparoscopic surgeries is deleterious to patients. This study was done to compare nalbuphine an agonist antagonist opioid with fentanyl, a gold standard opioid, when used in patients undergoing laparoscopic appendectomy under general anesthesia. Materials and Methods: This study included 60 ASA I patients who underwent elective appendectomy were randomised to receive either nalbuphine 0.1mg/kg or fentanyl 2µg/kg as analgesics 5 minutes prior to intubation. Heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were recorded at baseline and at every 2 minutes post intubation till the end of surgery. The time of laparoscopic port insertion and creation of pneumoperitonium was noted. Independent student‘t' test and chi square test was used to analyse continuous variables and categorical variables respectively. Results: The changes in heart rate were comparable between both groups at all time points of observation. Nalbuphine and fentanyl group showed an increase in heart rate of 3.81% and 6.03% respectively. Mean arterial pressure was comparable at all time points of observation except at the time of insertion of second port wherein fentanyl group showed 12.70% increase as compared to 4.54% fall from baseline in nalbuphine group. Side effects were comparable between both groups except sedation which was significantly more in nalbuphine group and pruritus more in fentanyl group. Conclusion: Nalbuphine due to its availability without license is an effective alternative to fentanyl in laparoscopic surgeries.