2013, Number 5
Comparison of nalbuphine vs. epidural buprenorphine for immediate postoperative analgesia in patients undergoing knee arthroscopy
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ABSTRACTIntroduction. 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 or vomit.
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