TOTAL INTRAVENOUS ANAESTHESIA (TIVA) WITH DEXMEDETOMIDINE VERSUS NALBUPHINE IN COMBINATION WITH PROPOFOL IN UPPER LIMB ORTHOPAEDIC CLOSED MANIPULATION PROCEDURE- A COMPARATIVE STUDY IN A TERSIARY HEALTH CARE CENTRE IN TRIPURA

Abstract

Background: Manipulation under anaesthesia is a closed short non-surgical procedure but it demands a cool and calm patient with immobility and relaxation of body parts, to be manipulated. Thus, the role of anaesthesia is vital for success of the procedure. At the same time, it is a challenge for the anaesthesiologist because immobility requires to be maintained and as these procedures are treated as minor, muscle relaxants and intubation are avoided. Adequate analgesia, rapid and complete recovery and controlled sedation is essential to avoid hospital stay.

Materials and Methods: It was an observational analytical study with longitudinal design. This study was conducted at AGMC & GBP hospital, Tripura and the duration was one and half year. Patient of sex, normal BMI and age between 20-60 years are served as study population. 60 cases are divided into two groups and coded as group D & N. Intra-procedural hemodynamic (MAP, HR, RR, SPO2), operation time, post procedural (up to 2 hour) pain by Wang – Baker faces pain rating scale and post procedural sedation by Ramsey sedation scale are observed and measured and analysed in this study.

Results: Intra-operative MAP and HR were significantly higher in nalbuphine group than Dexmedetomidine group (p<0.05). No significant difference was there in RR and SPO2 (intra-operative). Recovery of orientation was significantly lesser in dexmedetomidine group. Post procedural perception of pain was significantly lower in dexmedetomidine group (P<0.005). Post procedural sedation was lower in Dexmedetomidine group which was statistically significant (P<0.005).

Conclusion: Dexmedetomidine is superior to nalbuphine in respect of recovery of orientation, pain control after procedure and control of sedation after procedure. Dexmedetomidine is superior to nalbuphine as it provides adequate analgesic and sedation without increasing MAP and HR in the above said procedure.

Keywords: Dexmedetomidine, Nalbuphine, MAP- Mean arterial pressure, HR- Heart Rate, RR- Respiratory Rate