Comparative Study of Postoperative Analgesia in Coronary Artery Bypass Grafting: Thoracic Epidural Nalbuphine versus Fentanyl - A Randomized Controlled Study

Author(s): Balajibabu Perumala Ramanna1 , Srinivasa Rao Janapati2 , Ananda Bhat3 , Naveen Govind Singh4 , Ashok Kumar5 , Manjunatha Narasimhaiah6

BACKGROUND Epidural analgesia provides superior analgesia, stable haemodynamics, decreased respiratory system complications, earlier extubation, and superior left ventricular function. When opioids are used as adjuvants to local anesthetics, they act synergistically, resulting in superior and prolonged analgesia. This also results in reduced adverse effects of both classes of the drugs. The present study was carried out to compare the efficacy of epidurally administered Nalbuphine and Fentanyl in the post-operative pain management. METHODS This randomized controlled trial involved 60 participants undergoing coronary artery bypass grafting. They were randomly allotted to two groups, each consisting of 30 participants. During the post-operative period, thoracic epidural was activated after extubation. One group received 10 mL of 0.25% Bupivacaine and 10 mg Nalbuphine through epidural catheter, and other group received 10 mL of 0.25% bupivacaine with Fentanyl 2 mcg/mL. The haemodynamic parameters and visual analog score (for pain assessment) were recorded throughout the study period and compared between the two groups. RESULTS Hypotension occurred in 16.7% in both the groups, bradycardia occurred in 10% of the participants in the Fentanyl group only. The need for rescue analgesia was similar in both the groups (6.7%). The mean duration of analgesia was 381 minutes in the Nalbuphine group compared to 285 minutes in the Fentanyl group. There was a statistically significant difference in the VAS score and duration of analgesia between the two groups (p<0.05). CONCLUSIONS Opioid analgesics are highly effective as adjuvants in post-operative pain management. In this study involving patients undergoing coronary artery bypass grafting, Nalbuphine was found to be effective in achieving adequate and prolonged post-operative analgesia, in comparison to Fentanyl.