Comparative Evaluation of Tramadol vs. Nalbuphine as Adjuvants to Ropivacaine in Supraclavicular Block: A Cross-Sectional Observational Study
Authors/Creators
- 1. Senior Resident, Department of Anesthesiology, Patna Medical College and Hospital, Patna, Bihar
- 2. Professor & HOD, Patna Medical College and Hospital, Patna, Bihar
- 3. Assistant Professor, Patna Medical College and Hospital, Patna, Bihar
Description
Background: Supraclavicular block is a prominent upper limb regional anaesthetic treatment that manages postoperative pain and delivers personalised anaesthesia. Adjuvants are often added to ropivacaine, a common local anaesthetic, to improve block effectiveness and longevity. This study assessed side effects, postoperative pain control, and sensory and motor block to determine the efficacy of tramadol and nalbuphine as adjuvants to ropivacaine in supraclavicular block. Methods: As an adjuvant to ropivacaine, 87 adult subjects were randomised to receive either nalbuphine (Group N, n=44) or tramadol (Group T, n= 43). Along with the incidence of side effects and postoperative pain scores at different intervals, the onset and duration of sensory and motor blocks were noted. Version 23.0 of SPSS was used to analyse the data, and a p-value of less than 0.05 was deemed statistically significant. Results: While the duration of both blocks was longer in the tramadol group (p < 0.001), the start of sensory and motor blocks was substantially sooner in the nalbuphine group (p < 0.001). At 4, 8, and 12 hours after surgery, the tramadol group’s postoperative pain assessments were reduced (p < 0.05). Between the two groups, the incidence of side effects, such as nausea, vomiting, and pruritus, was similar and did not differ statistically. Conclusion: Nalbuphine started sensory and motor block faster, while tramadol lasted longer and controlled early postoperative pain better. Most side effects were minor with both adjuvants. Tramadol is better for prolonged anaesthesia or postoperative analgesia than nalbuphine as ropivacaine adjuvants. Recommendations: It is advised to conduct more research with bigger sample sizes and a wider range of patients to validate these results and investigate the possible advantages of combining these adjuvants for the best results in supraclavicular block.
Abstract (English)
Background: Supraclavicular block is a prominent upper limb regional anaesthetic treatment that manages postoperative pain and delivers personalised anaesthesia. Adjuvants are often added to ropivacaine, a common local anaesthetic, to improve block effectiveness and longevity. This study assessed side effects, postoperative pain control, and sensory and motor block to determine the efficacy of tramadol and nalbuphine as adjuvants to ropivacaine in supraclavicular block. Methods: As an adjuvant to ropivacaine, 87 adult subjects were randomised to receive either nalbuphine (Group N, n=44) or tramadol (Group T, n= 43). Along with the incidence of side effects and postoperative pain scores at different intervals, the onset and duration of sensory and motor blocks were noted. Version 23.0 of SPSS was used to analyse the data, and a p-value of less than 0.05 was deemed statistically significant. Results: While the duration of both blocks was longer in the tramadol group (p < 0.001), the start of sensory and motor blocks was substantially sooner in the nalbuphine group (p < 0.001). At 4, 8, and 12 hours after surgery, the tramadol group’s postoperative pain assessments were reduced (p < 0.05). Between the two groups, the incidence of side effects, such as nausea, vomiting, and pruritus, was similar and did not differ statistically. Conclusion: Nalbuphine started sensory and motor block faster, while tramadol lasted longer and controlled early postoperative pain better. Most side effects were minor with both adjuvants. Tramadol is better for prolonged anaesthesia or postoperative analgesia than nalbuphine as ropivacaine adjuvants. Recommendations: It is advised to conduct more research with bigger sample sizes and a wider range of patients to validate these results and investigate the possible advantages of combining these adjuvants for the best results in supraclavicular block.
Files
IJPCR,Vol16,Issue4,Article264.pdf
Files
(284.9 kB)
| Name | Size | Download all |
|---|---|---|
|
md5:11092d282a3f3ab3c904a48f7020632e
|
284.9 kB | Preview Download |
Additional details
Dates
- Accepted
-
2024-04-05
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/16/IJPCR,Vol16,Issue4,Article264.pdf
- Development Status
- Active
References
- 1. Ilfeld BM, Eisenach JC, Gabriel RA. Clinical Practice and Future Approaches. Reg Anesth Pain Med. 2019;44(2):201-6. 2. Sen S, Jacob I, Vasudevan A. Comparative study of tramadol as an adjuvant to local anesthetics in regional blocks: A systematic review. J Clin Anesth. 2020; 62:109730. 3. Mishra S, Mandal R, Khanna P. Nalbuphine as an adjuvant in regional anesthesia: A systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2021;24(3): 237-48. 4. Singh P, Yadav A, Chaturvedi A. Efficacy of nalbuphine as an adjuvant to ropivacaine in brachial plexus block: A randomized controlled trial. J Clin Diagn Res. 2021;15(4):7-11 5. Kumar R, Gupta N, Sharma A. Comparative evaluation of tramadol and nalbuphine as adjuvants to ropivacaine in brachial plexus block: A randomized controlled trial. Indian J Anesth. 2020;64(8):664-70. 6. Jain K, Sethi S, Gupta S, Khare A. Efficacy of nalbuphine as an adjuvant to 0.5% ropivacaine for ultrasound-guided supraclavicular brachial plexus block in upper limb surgeries: A prospective randomized double-blind study. The Indian Anaesthetists Forum. 2019; 20:82-88. 7. Kalika P, Xue R, Zheng J, Xiao Y, Zhen M, Ran R. Efficacy of Nalbuphine as an Adjuvant to Ropivacaine in Ultrasound-guided Supraclavicular Brachial Block. The Clinical Journal of Pain. 2020; 36:267-272. 8. Arish B, Hariharasudhan B, Ranjan R, Sivakumar S, George S, Ravichandran K. Anaesthetic Efficacy of Nalbuphine as an Adjuvant to Ropivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Blockade: A Randomised Controlled Trial. Journal of Clinical and Diagnostic Research. 2021. 9. Jayara A, Bhandari G, Shahi K. Comparative study of analgesic effect of intrathecal nalbuphine and tramadol in patients undergoing vaginal hysterectomy. International Journal of Biomedical and Advance Research. 2018; 9:136- 141. 10. Kumari A, Chhabra H, Gupta R, Kaur H. Comparative Study of Effectiveness of Tramadol and Butorphanol as Adjuvants to Levobupivacaine for Supraclavicular Brachial Plexus Block. Anesthesia, Essays and Researches. 2019;13:446-451.