Analgesic Efficacy of Levobupivacaine versus Levobupivacaine with Nalbuphine in Surgical Site Infiltration Technique for Lower Abdominal Surgeries: A Randomised Controlled Study

Abstract

Introduction: Wound site infiltration with local anaesthetic agents is one of the simplest and safest techniques, improving postoperative analgesia as part of multimodal analgesia following general or regional anaesthesia. Adding an adjuvant to local wound infiltration can provide a longer duration of analgesia with fewer side-effects. Aim: To compare the analgesic efficacy of local wound infiltration with levobupivacaine alone versus a mixture of levobupivacaine and nalbuphine for postoperative pain. Materials and Methods: A double-blind randomised controlled study was conducted on 100 patients in GCS Medical College, Hospital and Research Centre, Ahmedabad, Gujarat, India. Patients were American Society of Anaesthesiologists (ASA) I-III, aged 18-70 years, and scheduled for abdominal surgeries. A standard general anaesthetic technique was used. Patients received local site wound infiltration during wound closure. A computer-generated random number was used to randomly divide patients into two groups. Group L received 18 mL of 0.25% levobupivacaine plus 2 mL of 0.9% normal saline (total of 20 mL), while Group LN received 18 mL of 0.25% levobupivacaine plus 2 mL of nalbuphine (20 mg), also totaling 20 mL for wound infiltration. Postoperative rescue analgesia was provided with intravenous injection paracetamol (1 g) on demand or whenever the Numeric Rating Scale (NRS) indicated a score of ≥5. Haemodynamic parameters such as Heart Rate (HR), Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP) were observed at intervals in the Post Anaesthesia Care Unit (PACU) and at 30 minutes, 1 hour, 2 hours, 4 hours, and 6 hours postoperatively. Side-effects of the adjuvant were also recorded. Chi-square tests and Independent t-tests were used to compare data between the two groups. R esults: Demographic data, such as age, weight, height, ASA grade, and gender, were comparable between both groups (p-value>0.05). The total duration of analgesia in group LN was 9.20±0.79 hours, compared to 4.5±0.71 hours in group L (p-value<0.001), with better quality of analgesia in the adjuvant group and no reported side-effects, such as nausea, vomiting, bradycardia, hypotension, or sedation. Haemodynamic parameters showed that the Pulse Rate (PR) was 74.22±6.65 bpm, Systolic Blood Pressure (SBP) was 121±7.77 mmHg, and DBP was 74±7.05 mmHg, which were more stable in group LN at the 4-hour and 6-hour intervals of the postoperative period. C onclusion: Nalbuphine was an effective adjuvant for a single short local wound infiltration. Moreover, the combination of levobupivacaine with nalbuphine was found to be superior to levobupivacaine alone in patients undergoing lower abdominal surgery.

Keywords

• adjuvant
• local administration
• local anaesthetics
• pain
• postoperative period