Comparision of Post Operative Analgesia Between Nalbuphine and Fentanyl as adjuvant with intrathecal Levobupivacaine for lower abdominal Gynaecological Surgeries

Spinal anaesthesiahas a rapid onset and complete motor blockade  and also simple to perform.It has lower incidence of failed block and the local anaesthetic requirement isless. Hence spinal anesthesia is a preferred anaesthetic technique for lowerabdominal surgeries. Adjuvants to local anaesthetics for intrathecaladministration has some advantages. They have synergistic action & intensify sensory block without increasing sympathetic block, reducedlocal anaesthetic drug dose, better hemodynamic stability with lesser sideeffects.

Fentanyl is a pure mu receptor agonist. The common mu agonist sideeffects are  nausea, vomiting, sedation, urinary retention andrespiratory depression. It is lipophilic in nature, with rapid onset of action following intrathecaladministration. The intrathecal drug administration does not producerespiratory depression. It improves anaesthetic quality without muchcomplications.  Nalbuphine is a mixedkappa agonist and mu antagonist opioid drug, which produces analgesia withoutmuch side effects of mu receptor agonist action.

Levobupivacaine is alocal anaesthetic amide which can produce better sensory and motor block withgood hemodynamic profile than bupivacaine. Levobupivacaine is less cardiotoxic than bupivacaine. (1) Many investigators have studied the characteristics of intrathecalnalbuphine & fentanyl with levobupivacaine.

The purpose of this study is to compare the efficacy of fentanyl & nalbuphine as adjuvants to intrathecal levobupivacaine for post-operativeanalgesia following lower abdominal gynaecological surgeries.