Comparison of nalbuphine and dexmedetomidine as an adjuvant to general anaesthesia in ear surgery

Background- As an anesthetic adjuvant, nalbuphine and dexmedetomidine have been shown to provide good perioperative hemodynamic stability with decrease in the intraoperative inhalational agents requirement and also provides adequate postoperative analgesia. Methods- 60 adult patients of ASA grade I and II were randomly divided into 2 groups of 30 each. Group A received Inj. Nalbuphine 0.3mg/kg i.v.and Group B received Inj. Dexmedetomidine 1 mcg/kg i.v. over 10 minutes, given prior to induction. All patients were observed for baseline pulse rate, SBP and DBP. Thereafter haemoynamic parameters were noted at different time intervals. The RE(response entropy) and SE(state entropy) was maintained between 40 and 60 and also the concentration of sevoflurane required to maintain adequate depth was noted.Postoperative analgesia was assessed by VAS score. Results- Intraoperatively there was no significant difference in the heart rate, SBP and DBP of patients of both the groups (p- value >0.05). But there was a transient rise in SBP and DBP and fall in heart rate in Group B immediately after administration of study drug. (p- value <0.05). The requirement of sevoflurane concentration was significantly less in Group A as compared to Group B intraoperatively (p>0.05). The mean duration of first rescue analgesia after surgery was 5hours 45 minutes in Group A whereas 2hours 15min in Group B. Conclusion- Both the drugs as an adjuvant to general an aesthesia attenuate stress response to various noxious stimuli and maintain hemodynamic stability throughout the surgery and decrease the requirement of inhalational agent. Nalbuphine provides better analgesia and reduces requirement of postoperative analgesia as compared to dexmedetomidine. Thus, nalbuphine is more advantageous adjuvant to general anaesthesia.