RESUMO
Background and Aims: Postoperative pain is a multitude of various irksome sensory, emotional and mental experiences aggravated by surgical trauma and associated with autonomic, endocrine, metabolic, physiological and behavioural responses. The aim of this study was to evaluate the effect of erector spinae plane block (ESPB) in postoperative analgesia following percutaneous nephrolithotomy (PCNL) under spinal anaesthesia. Methods: This prospective randomised study was conducted on sixty American Society of Anesthesiologists physical status I and II patients scheduled for PCNL under spinal anaesthesia. They were randomised into two equal groups of thirty patients. ESPB was given in group A with 20 ml of injection bupivacaine 0.25% and dexamethasone 8 mg and group B received injection tramadol 1.5 mg/kg intravenously immediately after PCNL. The primary outcome was comparison of visual analogue scale (VAS) score in the first 24 h postoperatively, whereas secondary objectives included hemodynamic variables and requirement of rescue analgesia. Results: VAS score in group A (ESPB) with mean of 3.15 ± 0.68 was comparatively low when compared to group B with mean of 6.61 ± 0.50 at 6 hours. After 4 h postoperatively, VAS scores continued to be higher and significant number of patients required rescue analgesia in group B. Conclusion: ESPB reduced VAS score, provided adequate postoperative analgesia, with similar haemodynamic changes and adverse effects in comparison to the conventional analgesia with tramadol in PCNL.
RESUMO
Objectives In this study, our primary aim was to compare the efficacy of and haemodynamic changes related to nalbuphine and tramadol when used for the control of post-spinal anaesthesia shivering, as per Wrench shivering grades. The secondary aim was to study the complications and adverse effects associated with the drugs. Methodology A total of 60 patients with the American Society of Anesthesiologists (ASA) physical status class I/II who were scheduled to undergo elective surgeries under spinal anaesthesia were divided into two groups of 30 each. Group N received intravenous nalbuphine 0.05 mg/kg and Group T received intravenous tramadol 1 mg/kg, two minutes after the patients started shivering after undergoing spinal anaesthesia. The anaesthesia technique was standardised for all the patients in the study. The shivering grade was measured using the Wrench shivering grade and the level of sedation was studied using the Ramsay Sedation Scale. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were recorded. All the parameters were measured at the baseline and at one, two, five, 10, 15, and 30 minutes after administering the drug. Results Immediately after giving the drug, the time taken to control shivering was significantly lower in Group T: 3.633 minutes. However both the drugs controlled shivering effectively. There were no significant haemodynamic changes in both groups, probably due to the lower dosage of drugs used in our study. A different set of side effects were seen in each group. In Group N, out of 30 patients, five (16.67%) patients were sedated, four (13.33%) had hypotension, and two (6.67%) had bradycardia, whereas In Group T, out of 30 patients, five (16.67%) patients had nausea, four (13.33%) had nausea and vomiting, and two (16.67%) had dizziness following the administration of the drug. Respiratory depression or itching was not seen in any patients in either group. Conclusion Based on our findings, both Intravenous nalbuphine 0.05 mg/kg and intravenous tramadol 1 mg/kg are effective in treating patients with post-spinal anaesthesia shivering; however, the time taken to control shivering is lower with tramadol than nalbuphine. Both the drugs resulted in minimal haemodynamic changes and adverse effects.