A Comparative Study of Nalbuphine and Fentanyl as Adjuvant to Thoracic Epidural Ropivacine for Post Operative Analgesia in Laparotomy Surgeries

Background: A prospective, double-blind, randomized study was carried out to compare the quality of postoperative analgesia and side-effect profile between epidurally administered fentanyl and nalbuphine as an adjuvant to 0.2% ropivacaine. Postoperative pain therapy for abdominal surgeries is important far beyond the perioperative period because sensitization to painful stimuli can cause postoperative morbidity. Materials and Methods: A total of 60 patients between the age of 18 and 65 years of American Society of Anesthesiologists (ASA) Class I E and II E who underwent laparotomy surgeries were randomly allocated into three groups. Group 1 received 13 ml of 0.2% ropivacaine with 10 mg (1ml) nalbuphine (Total volume 14 ml), Group 2 received 13 ml of 0.2% ropivacaine with 50?g (1ml) fentanyl in epidural catheter (Total volume 14 ml) and Group 3 received 14 ml of 0.2% ropivacaine in thoracic epidural catheter. Quality of analgesia, cardiorespiratory parameters, side-effects, and the need of rescue intravenous analgesia were observed. Results: Mean VAS score was lower in G 1 (0.75?0.91) and it was statistically significant when compared to G 2 (1.35?0.99) and G 3 (1.55?1.05), (p value = 0.035). Thus the requirement of 24 hours rescue analgesic in term of number was lower in G 1(0.50?0.61) when compared to group 2 (0.85?0.67) and group 3 (2.20?0.70), which was statistically significant. (p value = 0.0001). Systolic BP, diastolic BP and mean arterial BP were maintained and comparable in all three groups during first 24 hours of postoperative period (p value greater than 0.05). Pulse rate was rate was lower and it was statistically significantly in first 15 minutes in group 3 as compared to group 1, group 2. (p value less than 0.05) However after that pulse rate was comparable in all three groups during first 24 hours of postoperative period (p value greater than 0.05). Side effects were comparable in group 1, group 2 and group 3 and were statistically insignificant. (p value greater than 0.05). Conclusion: Thoracic epidurally administrated ropivacaine with nalbuphine is more effective than ropivacaine with fentanyl for postoperative analgesia up to 24 hours of the postoperative period in laparotomies.