Nalbuphine over Fentanyl as adjuvant to intrathecal Bupivacaine in Cesarean cases-Randomised Double Blind Control

Spinal anaesthesia is the most popular and common regional technique for lower abdominal and lower limb surgeries. Opioids are one among such adjuvants having synergistic action with local anaesthetics and intensify the sensory blockade.

Fentanyl is a lipophilic opioid and mu receptor agonist, which on intrathecal injection has rapod onset, improves quality of anaesthesia, post operative analgesia, haemodynamic stability. It is a commonly used opioid adjuvant with intrathecal bupivacaine. However, the addition of intrathecal Fentanyl was associated with higher incidence of pruritus. However, small doses of Fentanyl(5-10mcg) are as effective as larger doses and may produce less itching.

Nalbuphine, a non-scheduled Kappa opioid receptor agonist and mu opioid receptor antagonist, has been in clinical use for post operative pain management and recently has been in clinical trials for chronic itch. Few studies have shown that intrathecal nalbuphine improves quality of block and provides significant post operative analgesia when added as an adjuvant to bupivacaine with minimal side effects.

Pruritus occurs as an unwanted and troublesome side effect of intrathecally administered opioids. It is bothersome to the patient and sometimes may be more unpleasant than pain itself for the patient. Also, parturients are more susceptible to neuraxial opioid induced pruritus. The treatment of intrathecal opioid induced pruritus also remains a challenge.

This study evaluates and compares the characteristics of spinal block and its effects in adult patients undergoing elective lower abdominal and lower limb surgeries who either received a subarachnoid block with Bupivacaine along with either Fentanyl/ Nalbuphine as adjuvant.