Intrathecal Nalbuphine versus Fentanyl as Adjuvants to Hyperbaric Bupivacaine in Hip Arthroplasty

Abstract Background Hip surgeries are one of the most cost-effective and consistently successful surgeries performed in orthopedics. Hip surgeries provide reliable outcomes for patients suffering from end-stage degenerative hip osteoarthritis (OA), specifically pain relief, functional restoration, and overall improved quality of life. Subarachnoid block is the preferred anesthesia for hip surgeries, being simple to perform and economical with rapid onset. Objective To compare intrathecal fentanyl in patients undergoing hip arthroplasty with nalbuphine as intrathecal adjuvant to 0.5% hyperbaric bupivacaine. The primary endpoint was the postoperative analgesia as assessed by VAS. The secondary outcomes were the onset and duration of sensory and motor blockade, hemodynamic changes, and incidence of side effects (bradycardia/ hypotension/ pruritus/ shivering/ respiratory depression/sedation). Patients and Methods This prospective double-blinded randomized clinical trial was conducted at Ain Shams University Hospitals from February 2022 until February 2023. Results As regard analgesic efficacy, there was increase pain in the two groups over the periods, but the most increase was in the fentanyl compared with nalbuphine group. There was a statistically significant difference between groups according to VAS score after 2:3 to 3:3 hours, while the rest times have insignificant difference. Sixteen patients received rescue analgesia with Fentanyl within 6h postoperatively, whereas six patients received with Naluphine which was found to be highly significant. Conclusion From our study we can conclude that there was increase pain in the two groups over the periods, but the most increase was in the fentanyl compared with nalbuphine group. There was a statistically significant difference between groups according to VAS score after 2:3 to 3:3 hours, while the rest times have insignificant difference. Sixteen patients received rescue analgesia with Fentanyl within 6h postoperatively, whereas six patients received with Naluphine which was found to be highly significant.