Comparison among Intrathecal Nalbuphine and Fentanyl in Combination with Chloroprocaine 1% for Short Surgical Lower Limb Procedures – A Prospective Randomized Control Trial

Abstract

Background: Preservative-free chloroprocaine (CP) 1% is being investigated for short surgeries but lacks immediate postoperative analgesia. Adding opioids to local anesthetic increases the quality of spinal anesthesia with prolongation of postoperative analgesia. Aim: The aim of this study is to compare the postoperative analgesic efficacy of intrathecal nalbuphine versus intrathecal fentanyl as an adjuvant to chlorprocaine 1% for short surgical lower limb procedures. Materials and Methods: After ethical committee approval, a prospective randomized double-blind comparative study was conducted on 90 patients of the American Society of Anesthesiologists classes 1 and 2, aged between 18 and 60 years who were scheduled for elective short surgical lower limb procedures. Group CP (n = 30) received CP 1% 40 mg (4 ml) plus saline (0.5 ml), Group CP with fentanyl (CF) (n = 30) received CP 1% 40 mg (4 ml) plus fentanyl 25 mcg (0.5 ml), and Group CP with nalbuphine (CN) (n = 30) received CP 1% 40 mg (4 ml) plus nalbuphine 0.8 mg (0.5 ml) intrathecally. After performing subarachnoid block, the parameters observed were – Onset, height, duration of sensory and motor blockade, duration of postoperative analgesia, hemodynamics, and adverse effects between the three groups noted. Results: The onset of sensory and motor block (min) is faster in Group CF (4.2 ± 0.2, 3.4 ± 0.4) compared to Group CN (4.8 ± 0.4, 3.7 ± 0.4) and Group CP (6.2 ± 0.4, 4 ± 0.4) (P < 0.001). The total sensory duration and motor duration are prolonged in Group CN (96.5 ± 5.2, 90 ± 3.9) compared to Group CF (94 ± 4, 87 ± 4.5) and Group CP (77 ± 3, 74 ± 4.5) (P < 0.001). The duration of postoperative analgesia was prolonged in Group CN (130 ± 5.3) compared to Group CF (111 ± 6.2) and Group C (93 ± 4.2) (P < 0.001). Conclusion: We conclude that intrathecal nalbuphine prolongs postoperative analgesia maximally compared to intrathecal fentanyl as an adjuvant to CP 1% for short surgical lower limb procedures.