Comparison of fentanyl and nalbuphine in obtunding stressor response to laryngoscopy and endotracheal intubation

Abstract

: Fentanyl has evinced its property of being a potent opioid and benumbing stress response to laryngoscopy and intubation (L&I). However respiratory depression and chest wall rigidity limits its utility at high doses. Nalbuphine, reported to have a ceiling effect for respiratory depression, can serve as an alternative. We studied and compared the efficacy of fentanyl and nalbuphine in preventing the rise in heart rate and blood pressure after L&I. A randomized double blind study was conducted in 60 subjects divided in two groups (Group F n=30 and Group N n=30) was done. Group F received 2µg kg fentanyl intravenously while group N received nalbuphine 0.2mg kg intravenously. Hemodynamic variables including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were measured at baseline and at intervals of five minutes of administering test drug, each minute up to five minutes after intubation, 10 minutes and 30 minutes after intubation. Complications, if any, were recorded after surgery. Change in HR, SBP, DBP and MAP between the two groups was compared using independent t-test. : The two drugs were equally effective in preventing HR rise at all-time points except after 30 minutes where fentanyl performed better. The change in SBP, DBP and MAP from baseline in both the groups was comparable.: Nalbuphine can serve as an alternative to fentanyl in obtunding stress response when given five minutes before intubation.