Original Research Article
Year: 2016 | Month: May | Volume: 3 | Issue: 5 | Pages: 43-53
Use of Patient Controlled Analgesia Using I.V. Tramadol and I.V. Nalbuphine for Postoperative Pain Management after Major Abdominal Surgery - A Comparative Study
Neha Chandrakar1*, Jaya Lalwani2*, K.K. Sahare3*, Smriti Bandhu1**
1Senior Registrar, 2Associate Professor, 3Professor and Head of Department,
*Department of Anaesthesiology and Critical Care, Pt J.N.M. Medical College, Raipur (C.G.).
**Medical College, Rajnandgaon.
Corresponding Author: Neha Chandrakar
Background & Objective: Postoperative pain relief is a major concern for reducing postoperative morbidity. Patient controlled analgesia is a better technique for pain relief and for avoidance of drug overdosing and abuse. Patient-controlled analgesia (PCA) is commonly assumed to imply on-demand, intermittent, IV administration of opioids under patient control (with or without a continuous background infusion). Tramadol and nalbuphine are two potent analgesic drugs with different mechanism of action in the central nervous system. Tramadol is a weak opioid agonist and is used in mild to moderate pain relief. Nalbuphine is a newer opioid drug with antagonism at μ receptor and agonism at κ receptor. The aim of this study was to compare the analgesic efficacy and side effects of these two drugs in PCA for postoperative pain relief.
Method: 80 patients ASA I and II, 40 patients in each group undergoing major abdominal surgery under general anaesthesia were allocated in these randomized, controlled, double blind study. They received either 10 mg tramadol or 2mg nalbuphine through PCA pump at complaint of pain. Pain assessment was done with visual analogue scale (VAS). Pain and sedation assessment was done at 30min, 3hrs, 6hrs, 15hrs, 18hrs, 21hrs, and 24hrs in postoperative period. Adverse effects and time of its occurrence, hemodynamic parameters, and respiratory rate were assessed for 24hrs. Vital parameters were monitored hourly for 24 hours.
Result: VAS score decreased with time in both groups. Mean VAS score at starting of PCA was 5±0.75 in Tramadol group and 4.775±0.69 in Nalbuphine group. The difference was not statistically significant. (p>0.05).After 30 mins mean VAS score was 3.8±0.79 in Tramadol group and 2.95±0.64 in Nalbuphine group. Both groups VAS score decreased with time but more in Nalbuphine group. The difference was statistically significant (p<0.05). Sedation score decreased throughout the study period. But mean sedation score was significantly more in nalbuphine group. Nausea was observed in 15% and 4% respectively in Tramadol group and Nalbuphine group. Vomiting was observed in 6% and 0% patients respectively in Tramadol group and Nalbuphine group. No other side effects were seen. The comparison of side effects between the two groups was statistically significant.(p<0.05).
Conclusion: I.V. Nalbuphine bolus administered through PCA is better for postoperative pain management after major abdominal surgery.
Key words: Abdominal surgery, analgesia, post‑operative pain.