A Randomized, Controlled Analysis of the Effects of Fentanyl, Morphine, and Nalbuphine in Reducing the Stress Response and Serum Cortisol Levels during Endotracheal Intubation

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Abstract (English)

Abstract
Aim: A comparative analysis of the effects of fentanyl, morphine, and nalbuphine in reducing the stress response
and serum cortisol levels during endotracheal intubation.
Material and Methods: This study employed a randomized, controlled, double-blind design and was conducted
in Department of Anesthesiology, NMCH, Patna, Bihar, India for one year. A total of 100 adult patients
scheduled for elective surgery requiring endotracheal intubation were included in the study. The inclusion criteria
were adults aged 18-65 years, ASA physical status I or II, patients scheduled for elective surgery under general
anaesthesia, and those who provided informed consent. Participants were randomly assigned to one of three
groups: fentanyl (Group F), morphine (Group M), or nalbuphine (Group N). Randomization was achieved using
a computer-generated randomization schedule. Both patients and clinicians were blinded to the group
assignments. Group F received 2 μg/kg fentanyl IV, Group M received 0.1 mg/kg morphine IV, and Group N
received 0.2 mg/kg nalbuphine IV. All medications were administered 5 minutes before induction of anaesthesia.
Results: The hemodynamic parameters, including heart rate (HR) and mean arterial pressure (MAP), at various
time points. At baseline, the mean HR and MAP were similar across the groups, with no significant differences
(HR: p = 0.91, MAP: p = 0.85). Pre-intubation, post-intubation, and 5 minutes post-intubation measurements also
showed no significant differences among the groups (pre-intubation HR: p = 0.78, post-intubation HR: p = 0.67,
5 min post-intubation HR: p = 0.73; pre-intubation MAP: p = 0.77, post-intubation MAP: p = 0.62, 5 min postintubation MAP: p = 0.80). These findings indicate that fentanyl, morphine, and nalbuphine had similar effects
on hemodynamic stability during the intubation process. The change in heart rate from baseline to post-intubation
was slightly higher in the morphine group (17.1 ± 3.1) compared to the fentanyl (14.4 ± 2.7) and nalbuphine (14.1
± 2.5) groups, but this difference was not statistically significant (p = 0.55). The change in MAP from baseline to
post-intubation was also higher in the morphine group (14.6 ± 2.8) compared to fentanyl (10.4 ± 2.2) and
nalbuphine (8.9 ± 2.0), but again, this difference did not reach statistical significance (p = 0.60). The change in
cortisol levels from baseline to 30 minutes post-intubation was slightly higher in the morphine group (4.7 ± 1.1)
compared to fentanyl (3.4 ± 0.8) and nalbuphine (3.3 ± 0.7), but this was not statistically significant (p = 0.72).
Conclusion: In conclusion, fentanyl, morphine, and nalbuphine are all effective in attenuating the hemodynamic
and endocrine stress responses during endotracheal intubation. There were no significant differences among the
three drugs in terms of their impact on heart rate, mean arterial pressure, or serum cortisol levels.