Precision Anesthesia: Nalbuphine-Levobupivacaine vs. Fentanyl-Levobupivacaine in Spinal Blocks
Abstract
Background: Intrathecal adjuvants enhance the efficacy of local anesthetics in spinal anesthesia. This study compared nalbuphine and fentanyl as adjuvants to hyperbaric levobupivacaine for lower abdominal surgeries.
Methods: In this prospective, randomized, double-blind study, 100 ASA I-II patients undergoing lower abdominal surgeries were allocated into two groups: Group LN (n=50) received 15 mg of 0.5% hyperbaric levobupivacaine with 0.8 mg nalbuphine intrathecally, and Group LF (n=50) received 15 mg of 0.5% hyperbaric levobupivacaine with 25 μg fentanyl intrathecally. Onset and duration of sensory and motor blockade, hemodynamic parameters, postoperative analgesia using Visual Analog Scale (VAS), and adverse effects were assessed.
Results: The onset of sensory block (2.795±0.599 min in Group LN vs. 2.625±0.562 min in Group LF; p=0.921) and time to complete motor block (10.38±1.081 min vs. 10.59±1.004 min; p=0.766) were comparable between groups. The duration of sensory block (282.29±23.09 min vs. 306.88±29.06 min; p=0.0001) and motor block (178.46±7.59 min vs. 242.96±39.17 min; p=0.0001) were significantly longer in Group LF. VAS scores were significantly lower in Group LN at 1.5, 2, 2.5, and 3.5 hours postoperatively (p<0.05). Hemodynamic parameters remained largely stable in both groups. The incidence of adverse effects was comparable, with pruritus observed exclusively in Group LF (4%).
Conclusion: Fentanyl provided prolonged sensory and motor blockade, while nalbuphine offered better early postoperative analgesia with faster motor recovery and absence of pruritus. Both adjuvants maintained hemodynamic stability with minimal adverse effects, suggesting their selection should be tailored to specific surgical requirements and desired recovery profiles.
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