الفهرس 
Regional Anesthesia and Cesarean SectionOnly 14 pages are availabe for public view
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Abstract
One of the main objectives of anesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal.
The use of opioids in intrathecal or epidural anesthesia has become common to increase postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use.
The purpose of this study was to assess the postoperative analgesic requirements and the spinally mediated analgesic effects of intrathecal nalbuphine as an adjuvant to intrathecal bupivacaine after cesarean section in comparison to intrathecal bupivacaine with fentanyl. Fourty eight female patients came to Eldemerdash Hospital for cesarean delivery. They were randomly allocated into two equal groups (24 patients) group (F) and group (N).
group (F): Bupivacaine-Fentanyl
Patients received an intrathecal injection of 2.5 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (25 µg) fentanyl.
group (N): Bupivacaine-Nalbuphine
Patients received an intrathecal injection of 2.5 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (0.8 mg) Nalbuphine.
All patients were assessed and monitored for: vital data, ECG for heart rate, and non-invasive arterial pressure, respiratory rate and arterial oxygen saturation, duration of analgesia, postoperative analgesia, time of first analgesic requirements adverse effects as: hypotension, bradycardia, pruritus, shivering, nausea and vomiting were recorded.
Results of this study
This study showed that the addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia prolonged the time of postoperative analgesia. In this study, there was no significant difference regarding the demographic data, duration of operation, maximum sensory level, and maximum motor blockade level. Adding to this, there was also no significant changes regarding the vital data of the patients. On the other hand, there was a significant difference regarding the duration of analgesia which was longer with nalbuphine, It was also noticed that with nalbuphine less patients required rescue analgesia in comparison to fentanyl. There was higher number of side effects recorded with fentanyl in comparison to nalbuphine.
Hence, intrathecal administration of nalbuphine as an adjuvant to bupivacaine after cesarean section can be recommended over fentanyl for better post-operative analgesia and less side effects.