A comparative study of epidural nalbuphine versus tramadol as an adjuvant to bupivacaine for post operative analgesia in lower limb orthopaedic surgeries

Post operative pain management plays a vital role in ensuring optimal patient recovery and satisfaction, particularly in lower limb surgery where pain can significantly impede mobility and rehabilitation. Epidural anaesthesia provides targeted analgesia with lesser complications. tramadol and nalbuphine are two frequently used opioids for epidural analgesia to reduce postoperative pain. This study aims to compare the post-operative analgesic efficacy of epidural nalbuphine versus epidural tramadol as adjuvant with inj. bupivacaine 0.125% in lower limb orthopedics surgery. This study aimed to compare the post-operative analgesic efficacy of epidural nalbuphine versus epidural tramadol as an adjuvant with inj. bupivacaine 0.125% in lower limb orthopaedic surgery. The primary objectives were the duration and quality of analgesia. Secondary objectives included an assessment of postoperative hemodynamic changes, sedation levels and associated side effects. 60 patients of ASA I and II aged between 18-60 years were randomized into two groups with 30 patients each. Group N received epidural 0.125% bupivacaine (9ml) with 10 mg nalbuphine (1ml) total 10 ml. Group T received epidural 0.125% bupivacaine (9ml) with 50mg tramadol (1 ml) total 10 ml. The drugs were administered when patient complained of pain (i.e. VAS >=4). It was observed that both the groups were found to have similar demographics and hemodynamic parameters. Epidural nalbuphine had faster onset of analgesia (8.4 ±0.69 mins v/s 10.7 ±0.68 mins), longer duration of postoperative analgesia (11.2 ±0.84 hours v/s 9.2 ±1.42 hours) and better quality of analgesia as compared to tramadol as an epidural adjuvant. Nalbuphine 10 mg when added as an adjuvant to 0.125% bupivacaine epidurally provided a faster onset, better quality and longer duration of postoperative pain relief as compared to Tramadol 50 mg.