EFFECT OF ADDITION OF BUPRENORPHINE VS NALBUPHINE TO 0.75 PERCENT HYPERBARIC ROPIVACAINE FOR THE SUBARACHNOID BLOCK IN INFRA-UMBILICAL SURGERIES

Subarachnoid block , also known as spinal anaesthesia , is a regional anaesthesia technique that involves the injection of a local anaesthetic into the subarachnoid space. This technique provides effective intraoperative anaesthesia and contributes significantly to postoperative pain management , which remains a critical component of enhanced recovery protocols in modern surgical practice. Ropivacaine has emerged as a suitable alternative local anaesthetic for subarachnoid blocks , offering reliable sensory and motor blockade with a favourable safety profile compared to other local anaesthetic.

Buprenorphine , a partial mu receptor agonist and kappa receptor antagonist ,offers unique pharmacological advantages , high potency, long duration of action, less potential for respiratory depression , minimal dependency and abuse potential.

Similarly nalbuphine a synthetic opioid agonist-antagonist acting primarily on kappa-receptors and partially inhibiting mu-receptors ,has gained attention for its ability to provide effective analgesia with potentially fewer side effects than pure mu-agonists.

Recent studies have demonstrated the efficacy of both buprenorphine and nalbuphine as intrathecal adjuvants, but comparative studies directly evaluating their relative benefits in combination with ropivacaine are scarce.

Given the evolving landscape of multi-modal analgesia and the move away from pure mu-agonists like fentanyl because of their side effects ,there is increasing interest in partial agonist drugs like nalbuphine and buprenorphine .