Indian Journal of Clinical Anaesthesia


Optimal dose of intrathecal nalbuphine for prevention of adverse effects related to intrathecal morphine in patients undergoing lower abdominal and lower limb surgeries under bupivacaine spinal anaest


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Author Details: Prashanth Kumar C, Chaitra U, Sathyajith Karanth A

Volume : 3

Issue : 2

Online ISSN : 2394-4994

Print ISSN : 2394-4781

Article First Page : 207

Article End Page : 213


Abstract

Background: Prolonged post-operative analgesic effect of intrathecal morphine is often limited by its adverse effects. This study was conducted to know the effect of three different doses of intrathecal nalbuphine in reducing adverse effects related with intrathecal morphine.
Methods: The study was performed in a prospective, randomized, observer-blind manner. Total of 120 patients  were divided randomly into four groups (n=30) to receive 100 micrograms of morphine alone (Group A), 0.5mg(Group B), 1.0mg(Group C), 1.5mg(Group D) of nalbuphine with 100 micrograms morphine. Post operatively patients were monitored for vital signs, SpO2, sedation, pain (VAS), presence of pruritus, nausea and vomiting, respiratory depression and urinary retention for 24 hours.
Results: Addition of nalbuphine decreases pruritus, nausea and vomiting in dose dependent manner with maximum effect at 1.5mg. No significant differences observed in vital signs, SpO2, sedation score, pain (VAS) score, duration of analgesia and total dose of analgesia required. None of the patients developed respiratory depression and urinary retention.
Conclusion: Present study provides evidence that addition of 1.5mg of intrathecal nalbuphine with 100micrograms of intrathecal morphine completely abolishes opioid induced pruritus and significantly reduces nausea and vomiting without reducing analgesic effect of morphine.

Key words
: Spinal anaesthesia, Morphine, Nalbuphine, Postoperative nausea and vomiting, Pruritus