European Journal of Cardiovascular Medicine

Introduction: Local wound infiltration is an effective, simple, and practical method of postoperative analgesia. Time and resource consumption is minor; while being more acceptable. A low incidence of complications; and no major contraindications have been noted, other than patient refusal or local infection. Various systematic reviews outline the benefits of adjuvants such as opioids, non-steroidal anti-inflammatory drugs, steroids, alpha-2 agonists, ketamine, etc. in increasing the analgesic efficacy and opioid-sparing effect when combined with local anaesthetic agents via wound infiltration; while also providing supportive evidence of the safety of these agents. Material and Method: The study was as a prospective double blind randomised controlled trial conducted between April 2022 to April 2023. The inclusion criteria were age 30 to 60 years, lumbar degenerative disc diseases needing posterior spinal fixation of one- or two-disc levels and of American Society of Anaesthesiologists (ASA) grade I/II. The criteria for exclusion were surgery of >2-disc levels (>3 vertebrae), surgery for non-degenerative spinal diseases, previous spinal surgery, osteoporosis and spondylolisthesis of grade III/IV, altered hepatic or renal parameters or ASA grade III/IV. Surgical decision was made according to the patient’s history, flexion extension radiographs and MRI, with consultations with the patient. Patients were then randomly allocated randomly in 2 groups by a computer-generated randomization. Group N received inj nalbuphine 10mg, 0.5 % inj bupivacaine 9ml and 10ml normal saline while group B received inj butorphanol 1mg, inj bupivacaine 9ml and normal saline 10 ml.  Results: At end of the recovery, patients in nalbuphine group had mild pain with mean NRS score 2.5±0.5. The pain remained mild in nature till 4 hours and then starts increasing slowly with NRS at 6 hours 3.8±0.7 and peaking between 6 and hours (table 2, figure 1). The hearts rate and MAP were also had similar trends with progressive increase from 4 hours and peaks at 8 hours. In the butorphanol group the mean NRS score at the end of recovery was 2.8±0.6 which was comparable to the that of nalbuphine group. It started to increase before 4 hours, with mean NRS score at 4 hours 3.8±0.7 and peaked between 4 and 6 hours. During intergroup comparison mean heart rates, MAP and NRS were comparable between the two groups at baseline, 0 hour and 2 hours. Significant difference in NRS score were observed among the two groups at 4 hours (p – 0.03), 6 hours (p-0.01) and 8 hours (p-0.006). After 8 hours the heart rate, MAP and NRS in both groups were comparable (p>0.05).  Conclusion: In this study we have compared the benefits and safety of two different opioids as adjuvants to local infiltration in spine surgery.  The study was done in similar group of patients of degenerative lumbar disease operated with similar surgery (lumbar spinal fixation and decompression) by a single surgeon. The results demonstrated that the NRS score remains low at both groups till 4 hours of recovery and the patients were haemodynamically stable with no tachycardia or increased blood pressure. In the butorphanol group the NRS score increase around 4 hours of recovery and the request for first rescue analgesia was between 4 and 6 hours, mean 289.7±46.8 minutes. But in nalbuphine group, NRS score remained low up to 8 hours and mean time for request of first rescue analgesia was 492.4±56.3 minutes.