Pain Management of Patients under General Anaesthesia Nalbuphine Alone or Nalbuphine with Ketorolac

Objective: To compare the efficacy of Nalbuphine alone versus Nalbuphine with Ketorolac for the management of pain in for open cholecystectomy under general anaesthesia. Study Design: Comparative prospective study. Place and Duration of Study: Anaesthesia department of CMH, Okara Cantt Pakistan, June 2019- March 2020. Methodology: Patients were divided into two Groups by the lottery method, Group-A, Nalbuphine (.12milligram/kilogram) and Group-B (Nalbuphine .06millig/kilogram+ Ketorolac 15milligram).They were all given standard anesthetic drugs and analgesics in above mentioned dose at the start of surgery. Patients were assessed regarding postoperative pain intensity using the Numerical Pain Rating Scale at 5minute, 30 minutes and 1 hour after shifting to recovery. Rescue analgesia for moderate to severe pain at 30 minutes was documented. Nausea, vomiting and sedation were also noted in both groups. Results: Sedation in Group A was 8(10.7%) as compared in Group-B 4(5.3%).The frequency of nausea and vomiting in Group A and Group-B was 6(8.0%), 4(5.3%), and 5(6.7%), 2(2.7%) respectively. Rescue analgesia being lower in Group-A compared to Group-B which was statistically significant, for moderate to severe pain at 30 minutes after shifting. Group-A 10(13.3%) of cases while Group-B 55(73.3%) of cases producing p-value 0.001.A statistically significant difference regarding pain score between both groups, p-value <0.001. Conclusion: Intravenous Nalbuphine (0.12 mg/kg) was more effective in reducing pain intensity and postoperative analgesic requirements after surgery as compared to Nalbuphine (.6mg/kg)+ Ketorolac (15mg) in combination.