Effectiveness Of Nalbuphine As An Adjuvant To Ropivacaine In Ultrasound Guided Supraclavicular Brachial Plexus Block - A Randomised Control Study

Authors

  • Pavana S
  • Prajwal Patel Hs
  • Chethanananda Tn
  • Raghavendra R

Keywords:

Nalbuphine, Supraclavicular Brachial Plexus Block, Ropivacaine

Abstract

Introduction: Supraclavicular brachial plexus block (SCBPB) provides excellent anaesthesia for upper limb surgeries. Ropivacaine is commonly used due to its favourable safety profile, but its single-shot effect may not suffice for prolonged postoperative analgesia. Nalbuphine, a mixed κ-agonist and µ-antagonist opioid, is a promising adjuvant with effective analgesia and minimal side effects. This study aims to evaluate the effect of adding nalbuphine (10 mg) to 0.75% ropivacaine in ultrasound-guided supraclavicular brachial plexus block.

Materials and Methods: This randomised controlled study included 60 patients undergoing upper limb surgeries, divided into two groups (n=30). Group A received 20 mL of 0.75% ropivacaine with 10 mg nalbuphine; Group B received 20 mL of 0.75% ropivacaine with 1 mL normal saline. Ultrasound-guided SCBPB was performed, and onset and duration of sensory and motor block, duration of analgesia, and hemodynamic parameters were assessed.

Results: Group A demonstrated significantly faster sensory (3.9 ± 1.2 vs 9.0 ± 1.8 min) and motor block onset (7.1 ± 1.4 vs 11.8 ± 2.0 min) compared to Group B (p < 0.001). Duration of motor block (810 ± 45 vs 665 ± 40 min) and analgesia (1020 ± 60 vs 801 ± 50 min) were significantly longer in Group A (p < 0.001). Hemodynamic and respiratory parameters remained stable in both groups, and no adverse effects were reported.

Conclusion: Nalbuphine (10 mg) significantly improves the onset and duration of sensory and motor blockade, as well as postoperative analgesia, when used as an adjuvant to ropivacaine in SCBPB, without compromising safety.

Downloads

Download data is not yet available.

References

Bruce BG, Green A, Blaine TA, Wesner LV. Brachial plexus blocks for upper extremity orthopaedic surgery. J Am Acad Orthop Surg. 2012;20(1):38-47.

Patacsil JA, McAulife MS, Feyh LS, Sigmon LL. Local anaesthetic adjuvants providing the longest duration of analgesia for single-injection peripheral nerve blocks in orthopedic surgery: A literature review. AANA J. 2016;84(2):95-103.

Ting PL, Sivagnanaratnam V. Ultrasonographic study of the spread of local anaesthetic during axillary brachial plexus block. Br J Anaesth. 1989;63(3):326-9.

Stienstra R. The place of ropivacaine in anaesthesia. Acta Anaesthesiol Belg. 2003;54(2):141-8.

Hickey R, Hoffman J, Ramamurthy S. A comparison of ropivacaine 0.5% and bupivacaine 0.5% for brachial plexus block. Anaesthesiology. 1991;74(4):639-42.

Bazin JE, Massoni C, Groslier D, Fenies V, Bittar M, Schoeffler P. Brachial plexus block: Effect of the addition of sufentanil to local anaesthetic mixture on postoperative analgesia duration. Ann Fr Anaesth Reanim. 1997;16(9):9-13.

Kohli S, Kaur M, Sahoo S, Vajifdar H, Kohli P. Brachial plexus block: Comparison of two different doses of clonidine added to bupivacaine. J Anaesthesiol Clin Pharmacol. 2013;29(4):491-5.

Pick CG, Paul D, Pasternak GW. Nalbuphine, a mixed kappa 1 and kappa 3 analgesic in mice. J Pharmacol Exp Ther. 1992;262(3):1044-50.

Guan YJ, Wei L, Liao Q, Fang QW, He N, Han CF, et al. Pain management after ambulatory surgery: A prospective, multicenter, randomised, double-blinded parallel controlled trial comparing nalbuphine and tramadol. BMC Anaesthesiol. 2020;20(1):204.

Chawda PM, Pareek MK, Mehta KD. Effect of nalbuphine on haemodynamic response to orotracheal intubation. J Anaesthesiol Clin Pharmacol. 2010;26(4):458-60.

Kiran KS, Vyas V, Patil S. Comparative efficacy and safety of intravenous tramadol and nalbuphine for pain relief in postoperative patients. Indian J Pain. 2018;32(2):96-101.

Kumar J, Sinha PK, Prasad BK, Simbha A. Comparative study of nalbuphine and tramadol for postoperative pain relief in patients of short surgical procedures under TIVA. Int J Contemp Med Res. 2017;4(4):977-9.

Madan A. Nalbuphine as an adjuvant to 0.75% ropivacaine for supraclavicular brachial plexus blockade. Int J Curr Med Appl Sci. 2017;16(2):66–70.

Yadav VK, Choudhary AK, Prasad MK, Jheetay GS, Kumar A, Shahid R. Role of nalbuphine as an adjuvant to ropivacaine in supraclavicular block- a randomized control study. Anaesth. pain & intensive care. 2019;23(2):186-191.

Kalika P, Xue R, Zheng J, Xiao Y, Zhen M, Ran R. Efficacy of nalbuphine as an adjuvant to ropivacaine in ultrasound-guided supraclavicular brachial block: a prospective randomized controlled study. Clin J Pain. 2020;36(4):267–72.

Downloads

Published

2025-07-16

How to Cite

1.
S P, Patel Hs P, Tn C, R R. Effectiveness Of Nalbuphine As An Adjuvant To Ropivacaine In Ultrasound Guided Supraclavicular Brachial Plexus Block - A Randomised Control Study. J Neonatal Surg [Internet]. 2025Jul.16 [cited 2025Oct.13];14(32S):5422-8. Available from: https://www.jneonatalsurg.com/index.php/jns/article/view/8318