COMPARATIVE STUDY OF FENTANYL, TRAMADOL AND NALBUPHINE IN ATTENUATION OF HAEMODYNAMIC RESPONSES IN LAPAROSCOPIC CHOLECYSTECTOMY

Hp Singh,Hod, Department Of Anaesthesia And Icu, Amar Hospital, Patiala, Punjab ,Consultant, Department Of Anaesthesia And Icu, Amar Hospital, Patiala, Punjab ,Jaspreet Singh,Naveen Kumar Jindal

doi:10.21474/ijar01/12530

Hp Singh, Hod, Department Of Anaesthesia And Icu, Amar Hospital, Patiala, Punjab + Show 3 more

Open Access

https://doi.org/10.21474/ijar01/12530

Copy DOI

Abstract

Background:-Numerous attempts have been made in the past to attenuate the haemodynamic responses occurring during laparoscopic cholecystectomy. The present study compared the effect of three opioids namely TRAMADOL, Fentanyl and Nalbuphine in obtundation of haemodynamic responses in laparoscopic cholecystectomy in terms of Heart rate, BP (SBP, DBP and MAP) and secondary aim was to calculate duration of analgesia and sedation score. Materials And Methods:-This was a randomised study comparing three opioid drugs- nalbuphine, fentanyl and TRAMADOL. It was carried out on 75 patients of either sex aged 18 - 60 years scheduled for elective laparoscopic cholecystectomy under GA. Subjects were enrolled into three groups- Group B (n= 25) patients received inj. TRAMADOL 2 mcg/kg IV, Group F (n= 25) received inj. Fentanyl 2 mcg/kg IV and Group N (n= 25) patients received inj. Nalbuphine 0.2 mg/kg 5 minutes before the induction. Result:-At the time of extubation, mean MAP in Group B, F and N was 99.88, 95.32 and 97.24 respectively. This difference is highly significant when compared statistically (p value is 0.005). Conclusion:-With this study, we conclude that the administration of intravenous fentanyl and nalbuphine five minutes prior to induction of anaesthesia helps in better obtundation of haemodynamic responses to laparoscopic cholecystectomy than TRAMADOL.

Highlights

Laparoscopic surgeries form an essence of today’s surgical practice because of its magnification, dexterity, less cosmetic scar, less post-operative pain and decreased hospital stay because of decreased morbidity and mortality.(1)pneumoperitoneum created to visualise intra- abdominal organs along with positional changes (Reverse Trendelenburg position) results in a significant haemodynamic and respiratory changes.(2)Corresponding Author:- Dr Hp SinghAddress:- HOD, Department of Anaesthesia AND ICU, Amar Hospital, Patiala, Punjab.Int
The cardiovascular changes are characterised by decrease in cardiac output and increase in systemic vascular resistance which in turn results in sudden tachycardia, hypertension and increased myocardial oxygen requirement
CO2 (Used for abdominalinsufflation) readily absorbed from peritoneal cavity into the circulation resulting inhypercapnia.(3). These changes though better tolerated in ASA I and II,patients can be detrimental in elderly and ASA III patients with compromised cardiovascular physiology.Various surgical methods like change in nature of insufflating gas, use of low intra-abdominal pressure, use of abdominal wall lift methods have been tried to decrease the haemodynamic alteration associated with pneumoperitoneum, but all with practicallimitations.(4)