COMPARISON OF NALBUPHINE VS DEXAMETHASONE WITH LEVOBUPIVACAINE IN ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK FOR PCNL SURGERIES: A COMPARATIVE OBSERVATIONAL STUDY

Background: The erector spinae plane (ESP) block is a safe, simple interfascial plane block that provides good analgesia after thoracolumbar surgeries. Percutaneous nephrolithotomy (PCNL) is a minimally pervasive surgery used for renal stones. Opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and other regional analgesia techniques have been described previously in managing postoperative pain, but there is still controversy in finding an ideal method. Hence, the current study was undertaken to investigate. Objective: This study was done to compare the efficacy of adding 10 mg Nalbuphine or 8mg Dexamethasone to 20 ml of 0.25% levobupivacaine in patients receiving ESP block scheduled for percutaneous nephrolithotomy surgery. Methods: 100 cases of the American society of anesthesiologists grade I & II patients who were posted for percutaneous nephrolithotomy were enrolled and divided into two groups of 50 each.Group(N) received 20 ml of 0.25%Levobupivacine with 10 mg Nalbuphine. Group (D) received 20 mlof 0.25%levobupivacaine with 8 mg dexamethasone., The visual analogue scale score at 30 mins, 2nd ,4th,6th,8th,12th,16th,24hrs and the time required for 1st rescue analgesia and consumption of opioid in 24 hrs after surgery for both groups were measured. Results:  The visual analogue scale score at 8th,12th 16th, and 24 hrs. in group N were significantly lower than GROUP D (p< 0.05). The time for first rescue analgesia was longer in group N (784.33 ± 11.47mins) compared to group D (384.77 ± 13.55mins) (P< 0.001). Total opioid consumption was lower in Group N (82.73 ± 12.49) compared to Group D (254.97 ± 13.11) (P < 0.001) Conclusion:  Nalbuphine is more effective than dexamethasone in prolonging the duration of analgesia, delaying the time of first rescue analgesia, and reducing total opioid consumption when added to local anaesthetics inerector spinae block.