Clinical Efficacy of Nalbuphine Versus Tramadol as Analgesic Adjuvant to Fentanyl During Major Abdominal Surgery Performed Under General Anesthesia- A Double Blind Randomized Study
Major Abdominal Surgery Performed Under General Anesthesia
Background: Noxious stimulation of surgery predictably leads to variable hemodynamic changes which can be modified by opioid analgesia. The present study was aimed to comparatively evaluate the clinical efficacy of Nalbuphine with Tramadol as analgesic adjuvant to fentanyl during major abdominal surgery performed under general anesthesia. Subjects and Methods: Sixty adult consenting patients of ASA grade I and II of either sex, were enrolled for the study. Patients of Group I N received Nalbuphine 10 mg and patients of Group II T received Tramadol 100 mg, intravenously, 15 min before induction of anesthesia. After propofol induction, the endotracheal intubation was facilitated by vecuronium bromide (0.1mg/kg) and anesthesia was maintained with isoflurane and nitrous oxide with 40% oxygen. Changes in heart rate and systemic blood pressure were noted as primary variables and postoperative nausea, vomiting, respiratory depression, shivering or pruritus were noted as secondary outcomes. Results: Patients of comparable demographic profile showed fall in heart rate and blood pressure with no statistically significant difference. After extubation, patients of nalbuphine group were sedated but arousable while patients of tramadol group were awake. Five patients of tramadol group suffered from nausea. None of the patients of nalbuphine group suffered from any nausea. No patient showed any episode of respiratory depression, shivering, pruritus or any other side effects. Conclusion: Nalbuphine and tramadol, both could provide effective attenuation of the hemodynamic response to surgical stress of major abdominal surgery, but few patients of tramadol group suffered from manageable nausea.