title: Epidural nalbuphine for postoperative analgesia in orthopedic surgery.
abstract: BACKGROUND
  The challenging task of postoperative pain relief comes within the realm of the anesthesiologist. Combined spinal epidural (CSE) anesthesia can be used as the sole technique for carrying out surgical procedures and managing postoperative pain using various drug regimes. Epidural administration of opioids in combination with local anesthetic agents in low dose offers new dimensions in the management of postoperative pain.
  
  
  OBJECTIVE
  Comparative evaluation of bupivacaine hydrochloride with nalbuphine versus bupivacaine with tramadol for postoperative analgesia in lower limb orthopedic surgeries under CSE anesthesia to know the quality of analgesia, incidence of side effects, surgical outcome and level of patient satisfaction.
  
  
  METHODS
  A prospective, randomized and double-blind study was conducted involving 80 patients of American Society of Anesthesiologists physical status I and II coming for elective lower limb orthopedic surgeries carried under spinal anesthesia.
  
  
  METHODS
  Anesthesia was given with 0.5% of 2.5 ml bupivacaine intrathecally in both the groups. Epidurally 0.25% bupivacaine along with 10 mg nalbuphine (group A) or tramadol 100 mg (group B) diluted to 2 ml to make a total volume of 10 ml was administered at sensory regression to T10.
  
  
  METHODS
  The data were collected, compiled and statistically analyzed with the help of MS Excel, EPI Info 6 and SPSS to draw the relative conclusions.
  
  
  CONCLUSIONS
  The mean duration of analgesia in group A was 380 ± 11.49 min and in group B was 380 ± 9.8 min. The mean sedation score was found to be more in group B than group A. The mean patient satisfaction score in group A was 4.40 ± 0.871 and in group B was 3.90 ± 1.150 which was found to be statistically significant (P < 0.05). We concluded that the addition of nalbuphine with bupivacaine was effective for postoperative analgesia in terms of quality of analgesia and patient satisfaction score as compared to tramadol.
authors.affiliation: Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India.
authors.forename: Veena
authors.initials: V
authors.lastname: Chatrath
authors.affiliation: Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India.
authors.forename: Joginder Pal
authors.initials: JP
authors.lastname: Attri
authors.affiliation: Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India.
authors.forename: Anju
authors.initials: A
authors.lastname: Bala
authors.affiliation: Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India.
authors.forename: Ranjana
authors.initials: R
authors.lastname: Khetarpal
authors.affiliation: Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India.
authors.forename: Deepti
authors.initials: D
authors.lastname: Ahuja
authors.affiliation: Department of Anaesthesia, Government Medical College, Amritsar, Punjab, India.
authors.forename: Sawinder
authors.initials: S
authors.lastname: Kaur
keywords: Combined spinal epidural; nalbuphine; postoperative analgesia; tramadol