Comparative Study Between Intrathecal Nalbuphine and Fentanyl as adjuvant with Ropivacaine in lower limb surgeries: A Prospective, Randomized,Double Blind Study

Intrathecal opoids are synergistic with local anaesthtics and intensify the sensory block without increasing the sympathetic block. They are commonly added to local anaesthetic for potentiating their effects, reducing their doses, and thereby reducing their complication and side effect. They also prolong the duration of post operative analgesia. Few studies investigated intrathecal nalbuphine with hyberbaric bupivacaine , and as for as we know, no study had been done using isobaric ropivacaine as local anaesthetic and intrathecal nelbuphine are added as adjuant  and compared for it postoperative analgesic effects with fentanyl.

The study is a randomized, double blind, parallel group trial comparing effeicacy and safety of intrathecal nalbuphine 500mcg and Fentanyl 25mcg with newer local anaesthetics isobaric Ropivacaine. The patient will be divided randomly using computer generated number  into two equal groups (n=50) : Group RN will receive 0.75% ropivacaine (2.5ml) and 0.5ml nalbuphine (500mcg), Group RF will receive 0.75% of ropivacaine (2.5ml) 0.5ml fentanyl (25mcg). All patients are clinically assessed and routein preop. investigation will be done before procedure.  Baseline parameter will be noted on arrival to OT room or preop room. All patient will be pre-loaded with Ringer solution 10ml/kg  before procedure. Under all aseptic and antiseptic precaution dural puncture was performed in sitting position in L3-L4 interspce with a 25 G Quinke spinal needle. Intraoperatively HR, NIBP, RR, SpO2 were recorded  at 5 minute interval. Primary outcome measures will be duration of analgesia and Block characteristics ( onset and duration of sensory and motor block). The secondary outcome will be changes in hemodynamics and adverse side effects.