A Comparison between Intrathecal Nalbuphine and Fentanyl for Intraoperative Pain Management during Uterine Exteriorization in Cesarean Section: A Randomized Controlled Trial

Sherif Abdullah Mohamed; Ahmed Elsonbaty; Mohamed Elsonbaty

doi:10.3889/oamjms.2021.6531

Authors

Sherif Abdullah Mohamed Department of Anesthesia, Surgical ICU and Pain Management, Cairo University, Cairo, Egypt https://orcid.org/0000-0001-6226-3656
Ahmed Elsonbaty Department of Anesthesia, Surgical ICU and Pain Management, Cairo University, Cairo, Egypt
Mohamed Elsonbaty Department of Anesthesia, Surgical ICU and Pain Management, Cairo University, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2021.6531

Keywords:

Exteriorization of the uterus, Intrathecal nalbuphine, Intrathecal fentanyl, Visceral pain

Abstract

BACKGROUND: Uterine exteriorization during cesarean section is linked to an increased incidence of visceral pain.

AIM: This study explored the ability of intrathecal nalbuphine to alleviate this accompanied pain to be used as an effective safer alternative to fentanyl, as there is almost no study compared between these agents to alleviate visceral pain induced by uterine exteriorization.

METHODS: This double-blinded randomized controlled research was done on 135 cases subjected to cesarean section with exteriorization of the uterus. Patients were randomized equally into F, N, and C groups which received 25 μg fentanyl, 800 μg nalbuphine, and 0.5 ml saline, respectively, added to intrathecal 0.5% hyperbaric bupivacaine. The occurrence of visceral and shoulder pain and their VAS, the need for rescue IV fentanyl, adverse events, hemodynamics, and Apgar scores were evaluated.

RESULTS: The incidence of visceral pain was 22.2%, 24.4%, and 66.7% for Groups F, N, and C, respectively. Patients who needed rescue IV fentanyl were 6.7%, 11.1%, and 60% for Groups F, N, and C, respectively. The statistical difference regarding these parameters was highly significant (p < 0.0001) between C group and both F and N groups but insignificant between F and N groups. Nausea, shivering, itching, and bradycardia were significantly lower (p < 0.05) in N group in comparison to F and C. HR had a significant difference between F group and both N and C groups.

CONCLUSION: Intrathecal nalbuphine is an effective safer alternative to fentanyl to control visceral pain induced by uterine exteriorization during cesarean delivery.

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