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ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 306-312

Pain control for laparoscopic hysterectomy with magnesium versus nalbuphine added to intraperitoneal bupivacaine: a randomized double-blinded study


1 Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2 Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Correspondence Address:
MD Marwa A.K Elbeialy
Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Abbassia, Cairo 11591
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_50_18

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Background Pain control for laparoscopic hysterectomy carries some concerns. Intraperitoneal bupivacaine either alone or with additives has been studied with favorable results. However, adding nalbuphine has not been sufficiently examined. This study aimed to compare between the addition of magnesium sulfate (MgSO4) or nalbuphine to bupivacaine regarding efficacy and drawbacks. Patients and methods A total of 80 female patients of American Society of Anesthesiologists I–II scheduled for laparoscopic hysterectomy in Ain Shams University hospitals were randomly distributed into two groups: group bupivacaine magnesium (BM) (n=40), in which patients received 30 ml of intraperitoneal bupivacaine 0.25% plus 30 mg/kg MgSO4, and group bupivacaine nalbuphine (BN) (n=40), in which patients received 30 ml of intraperitoneal bupivacaine 0.25% plus 5-mg nalbuphine at the end of operation. A standard general anesthesia technique was used in all patients. Visual analog scale, total intravenous diclofenac consumption, the time for first analgesia requirement, incidence of adverse effects, and patient satisfaction in the first 24 h postoperatively were recorded in both groups. Results BN group experienced prolonged postoperative pain-free period. Total diclofenac consumption and pain scores were significantly less in BN group as compared with BM group. Regarding the adverse effects, there was insignificant difference between both groups for incidence of shoulder pain; however, BN group experienced more postoperative nausea and vomiting. Other adverse events were not reported. Patient satisfaction was significantly higher in BN group when compared with BM group. Conclusion This study showed that addition of nalbuphine to bupivacaine for intraperitoneal instillation gave better postoperative pain control when compared with adding MgSO4 to bupivacaine.


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