A prospective randomized comparative study of gelfoam soaked nalbuphine vs. ketamine placed in epidural space during lumber spine surgery for postoperative analgesia

Abstract

Background: Pain management is a major challenge after spine surgery. Parenteral opioids have been the mainstay of treatment for postoperative pain after lumbar spine surgeries. The biggest drawback of parenteral route is that drugs are given in large time gaps while ideal postoperative analgesia should provide continuous pain relief. Hence epidural route of analgesia has evolved as a critical component of pain management. We compared gelfoam soaked nalbuphine vs. ketamine placed in epidural space during lumber spine surgery for postoperative analgesia.
Methods: A prospective randomized, double-blind study of 60 patients of either sex between the age group of 18-60 years belonging to American Society of Anesthesiologists (ASA) grade I or II, posted for elective one or two segment laminectomy were included in the study. Patients were randomly allocated into three groups (20 patients each). In Group K gelfoam soaked in 50 mg of preservative free ketamine diluted with 5 ml normal saline was used. Group N patients received gelfoam soaked in 10 mg nalbuphine diluted with 5 ml normal saline and in Group C gelfoam soaked in 5 ml normal saline was placed in the epidural space just before wound closure.
Results: The total rescue analgesic (inj. Diclofenac sodium 75 mg) consumption in Group K was 90 ± 86.37 mg compared to 150 ± 91.04 mg in Group N (P= 0 .019) and time of 1^st analgesic requested was also significantly delayed in Group K compared to Group N (P= 0.00048). Visual analogue scale (VAS) scores were also lower in Group K during a period of 48 hours.
Conclusion: Epidural application of gelfoam soaked ketamine and nalbuphine both are effective method for maintaining postoperative analgesia, but ketamine shows better response in terms of lower pain scores and lesser rescue analgesic consumption than nalbuphine with lesser adverse effects.
Citation: Giri MK, Singh V, Pal P, Mishra LS, Gopal NN. A prospective randomized comparative study of gelfoam soaked nalbuphine vs. ketamine placed in epidural space during lumber spine surgery for postoperative analgesia. Anaesth Pain & Intensive Care 2018;22(4):­­492-498
Received – 9 Apr 2018; Reviewed – 14, 23 May 2018; Corrected & Accepted – 28 Dec 2018