Comparison of the effect of I.V nalbuphine and fentanyl as premedicant in general anaesthesia for laparoscopic surgeries

Abstract

Introduction: Laparoscopic surgeries are minimally invasive surgeries with reduced mortality and morbidity, minimal postoperative analgesic requirement and early mobilisation. To prevent hemodynamic response to laryngoscopy, intubation and pneumoperitoneum various drugs are used. Opioids are commonly used in premedication, being a good analgesic, to support analgesia during surgery and to provide pain relief in immediate postoperative period. Among opioids, Fentanyl and Nalbuphine effectively control the hemodynamic stress response associated with laparoscopic surgeries, especially after laryngoscopy, intubation and pneumoperitoneum. In our study, we observed and compared the potency of opioids- Fentanyl & Nalbuphine used as premedicant for attenuation of hemodynamic response in laparoscopic surgeries and postoperative complications if any. Objectives: The present study was designed to compare the effect of intravenous Nalbuphine and Fentanyl as premedicant in general anaesthesia for laparoscopic surgeries. Material and Methods: After institutional ethics committee approval, the study in 60 patients belonging to ASA 1 & 2 undergoing laparoscopic surgeries like appendectomy, cholecystectomyetc. whose duration was assumed to be <90 min under general anaesthesia was conducted. Pre-anaesthetic assessment of the patient was done with a complete history, physical examination and routine investigations and informed written consent was obtained. Eligible patients who gave consent were kept nil orally for at least 6 hours before surgery. Pulse Rate(PR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure(DBP), Mean Arterial Pressure (MAP), Oxygen Saturation (SpO2) was recorded at baseline, after giving study drug, immediately after laryngoscopy and tracheal intubation, thereafter at 10 minutes interval intraoperatively, post extubation at 1,3 and 5 minutes. Preoperative and postoperative sedation scoring was done using RASS. Results: The mean heart rate increased post extubation in both the groups. At 1min, 3 min and 5mins post extubation heart rate is better controlled in group N than group F and is statistically significant (P value < 0.05). Both groups showed a rise in SBP immediately after intubation. Group N showed a significantly lower SBP in comparison to group F (p<0.005). The DBP showed a similar trend. At one, three, and five minutes after intubation, HR, SBP, DBP, and MAP were similar between the groups. Post-extubation sedation score was significantly higher in group N (p < 0.005). Conclusions: From the findings of our study it is concluded that I.V. Nalbuphine when given in the dose of 0.2 mg/kg as a premedicant is significantly effective in attenuating the haemodynamic responses during intubation, laryngoscopy and pneumoperitoneum in laparoscopic surgery when compared to Fentanyl 2.0 μg/kg. It also provides better hemodynamic stability without major side effects during laparoscopic surgery.