الفهرس 
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Abstract
This prospective, randomized, double-blinded, placebo controlled study was carried out at the department of anesthesia and intensive care in El-Minia University Hospital during the period from March 2017 to November 2017 on a total 90 patients of either sex (ASA) physical status I and II who undergo elective laparoscopic cholecystectomy surgery under general anesthesia after institutional approval and written informed consents obtained from all patients prior to performing the study.
Patients were randomly divided in to three equal groups of 30 patients in each group; group C (control group) received 50 cc normal saline. group B (bupivacaine group) received 50 cc normal saline containing 100 mg bupivacaine (20 ml bupivacaine 0.5%). group BN (bupivacaine-nalbuphine group) received 50 cc normal saline containing 100 mg bupivacaine plus 10 mg nalbuphine. All the previous medications supplied in coded syringe in a double blind fashion to be instilled intra-peritoneal after gall bladder removal.
Our objectives were to compare and evaluate the postoperative analgesic effect of intraperitoneal instillation of bupivacaine 100 mg (20 ml bupivacaine 0.5%) with that of bupivacaine 100 mg (20 ml bupivacaine 0.5%) combined with nalbuphine 10 mg in patients undergo laparoscopic cholecystectomy surgeries.
All patients were assessed with regards to:
• Hemodynamics (HR, MAP) and oxygen saturation were recorded preoperatively as a baseline value adding to ETCO2 were assed at 5 min after intubation , then every 10 min during surgery and at end of surgery. After recovery HR, MAP and oxygen saturation were recorded immediately after recovery, at 10, 20 and 30 min post recovery.
• Post-operative pain by visual analogue pain score (VAPS) immediately after full recovery and at 1, 2, 4, 6, 8, 10, 12,16 and 24 hrs post-operatively.
• The time to first analgesic request and total postoperative 24 hrs. analgesic consumption.
• Incidence of occurrence any side effects.
The results of this research revealed that there was significant difference in hemodynamics (HR and MAP) immediately after recovery, 10, 20, and 30 min after recovery with more steady values detected in Bupivacaine-Nalbuphine group followed by Bupivacaine group and lastly Control group. Earlier and better control of postoperative pain was recorded in Bupivacaine-Nalbuphine group then Bupivacaine group when compared to Control group immediately after full recovery and at 1, 2, 4, 6, 8, 10, 12, 16 and 24 hrs. reflected by a statistically significant lower visual analogue pain score (VAPS), longer time of first analgesic request where in (BN) group was 11.5±0.9, in (B) group was 7.5±0.9 while in (C) group was 0±0 and decrease the total postoperative analgesic requirement. This research recorded fewer incidences of nausea and vomiting in bupivacaine-nalbuphine group followed by bupivacaine group when compared to control group. No other side effects were recorded in the three groups.
We conclude that the addition of 10 mg nalbuphine to 100 mg bupivacaine provides superior analgesia than bupivacaine alone as reflected by longer duration of analgesia and less analgesic rescue requirements within 24 hrs. Postoperatively.