>Revista de Sanidad Militar
>Year 2013, Issue 5
Velázquez-Delgado E, Crisóstomo-Pineda MM, Hernández-Pérez AL
Comparison of nalbuphine vs. epidural buprenorphine for immediate postoperative analgesia in patients undergoing knee arthroscopy
Rev Sanid Milit Mex 2013; 67 (5)
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Introduction. At our hospital, often the management of the immediate
post-operative period in patients undergoing orthopedic surgery
of the lower limb is carried out by the anesthesiologist in the
recovery room. In general, pain management is achieved as is traditional
with various analgesics, antipyretics, and conventional antiinflammatories
(NSAIDs) which ocassionally do not control pain in
its entirety, causing physiopathological alterations. Having a variety
of methods and techniques for pain control is beneficial to the patient,
thus preventing factors that may further alter the physiological
state of the patient. One of these techniques is the administration of
opioids via epidural (nalbufina, buprenorphine, fentanyl, morphine,
etc.) which can provide better results in the control of post-operative
immediate pain, showing that they are safe in appropriate doses,
without having side effects such as nausea, vomiting or, in extreme
cases, respiratory depression.
Objective. To compare the analgesia provided by nalbufina and
buprenorphine via epidural for the management of immediate postoperative
pain as well as to assess the presence of side effects in
patients undergoing arthroscopic knee surgery.
Materials and methods. 52 patients divided into two groups
participated. Noninvasive monitoring was performed in the OR and
basal preoperative cardiac frequency, electrocardiography, blood pressure
with sphygmomanometer, and pulseoximeter heart rate data were
measured. An epidural block was applied under conventional techniques
(of asepsis and antisepsis), followed by the conventional local
anesthetic (lidocaine with epinephrine at 2%, 240 to 280 mg) in L2-
L3 in preparation for the surgical event leaving a permeable cathe-
ter in cephalic direction. No benzodiazepines or intravenous
opioids were administered to the patients. At the end of the
surgery, the permeability of the catheter was assessed, before
administering the medications being studied, prior to the departure
from the operating room. Patient monitoring was done in the recovery
room, where the response to pain with each drug was measured by
means of the analog numerical scale, evaluating the application of
rescue analgesics. Group I received 10mg of Nalbufina (1cc) in 9cc
of physiological solution via epidural. Group II received 0.3 mg of
buprenorphine (1 cc) in 9cc of physiological solution via epidural.
Results. 52 patients were studied, none was eliminated. The
population did not present normal parametric distribution and
was distributed in two groups. When comparing demographic
variables no significant statistical differences were found in any
of them. As far as the transanesthetic systolic pressure, a statistically
significant difference was found in the nalbufina group. However,
when the transanesthetic diastolic pressure was evaluated, a
p = 0.00 was also obtained in favor of buprenorphine. Peripheral
oxygen saturation presented more variations in the nalbufina group
with a p = 0.002, not so in the buprenorphine group. As to pain
evaluation, it was done using the Analog Numerical Scale every 15
minutes. At 15, 45 and 60 minutes, p ‹ 0.05 was obtained, as
opposed to the pain evalation at 30 minutes. As to reported side
effects assessed at 15 minutes, itching and nausea were the most
frequent symptoms (67%) in the buprenorphine group, and only
29% of the nalbufina group presented itching. When these ítems
were reevaluated at 45 and 60 minutes, we found that only 17% of
patients in the buprenorphine group continued itching. Neither
group presented respiratory depression, cardiovascular instability
||Epidural Analgesic Dose, postoperative pain, Analog Numerical Scale, nalbufina, buprenorphine, side effects.
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>Revista de Sanidad Militar
>Year 2013, Issue 5