Comparative Study between the Analgesic Efficacy of Bupivacaine versus Bupivacaine and Nalbuphine in Ultrasound Guided Adductor Canal Block Post Knee Arthroscopy

Abstract

Abstract Background Knee arthroscopy (KA) is associated with significant postoperative pain. The need for effective analgesia without compromising function is a priority. However, despite the effectiveness of this approach, the rehabilitation of limbs after a KA operation still faces critical challenges. Pain is the most difficult factor to control following KA; however, the development of an ultrasound- guided nerve block and multi- modal analgesia and motor- sparing regional anesthetic blocks has helped to reduce postoperative pain to a certain extent to help achieve early limb autonomous movement and facilitates early knee range of motion (ROM), speed up the rehabilitation process, reduces overall narcotic consumption, shorten hospital stays, and improve patient satisfaction. Aim of the Work to compare the analgesic effect of Bupivacaine and Bupivacaine/nalbuphine in adductor canal block in patients undergoing knee arthroscopy as regard post operative pain management. Patients and Methods This study is a Prospective, Randomized, Controlled study. After obtaining approval from Research Ethics Committee of Ain Shams University, the study was conducted on 50 patients in the operating theatres of Ain Shams University. Results The two groups were adequately monitored and assessed post-operatively for 24 hours and they were compared regarding NRS postoperative, by recording time for first for analgesic need and total consumption of opioid. Side effects were also monitored and compared. As for the comparison between effect of Adductor canal block with Bupivacaine alone and Bupivacaine with Nalbuphine as regard post-operative pain in knee arthroscopy, it showed that there is significance regarding the numeric rating score (NRS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block with Bupivacaine and Nalbuphine and 2-4 for Adductor Canal block with Bupivacaine alone. These findings with our study primary and secondary outcomes showed that Adductor canal block with Nalbuphine has more analgesic effect regarding pain assessment and also with significant difference regarding the time of first analgesia postoperative and Total analgesics consumption (in mg.) over 24-hour period post-operative, but there was no significant difference regarding post operative complications such as hypotension, nausea and vomiting. Conclusion the comparison between effect of Adductor canal block with Bupivacaine alone and Bupivacaine with Nalbuphine as regard post-operative pain in knee arthroscopy, it showed that there is significance regarding the numeric rating score (NRS) that was used to assess postoperative pain and its intensity with range 1-3 for Adductor canal block with Bupivacaine and Nalbuphine and 2-4 for Adductor Canal block with Bupivacaine alone.