Mirza Osman Beg1, Abdus Samad2, Md Monzur Rahman3, Habiba Akther4
1. Associate Professor, Department of Orthopedics, North East Medical College, Sylhet.
2. Assistant Professor, Department of Orthopedics, North East Medical College, Sylhet.
3. Assistant Professor, Department of Orthopedics, Rajshahi Medical College, Rajshahi.
4 Associate Professor, Department of Obstetrics and Gynaecology, North East Medical College, Sylhet.
Abstract
Orthopedic surgery is always related to variable degree of of pain at post-operative period of immobilization. This increase post-operative morbidity and mortality. Therefore an effective management of post-operative pain is essential. Out of necessity to find out an effective and safe analgesic to control post-operative pain in orthopedic surgery, this study was designed as a double blind randomized clinical trial to compare the effects of Inj. Ketorolac and inj. Nalbuphine. This study was conducted in the Department of orthopedics in North East Medical college Hospital, Sylhet and some private clinic, Sylhet. Among 132 respondents who fulfilled the selection criteria (inclusion criteria: patient undergoing elective orthopedic surgery and Age >18 years, exclusion criteria: patients with cardiac renal, hepatic or immunologic disease, patients who has allergy to any drugs under study and patient with active psychiatric disorder) were selected by random method. Among the sample 65(49.24%) were treated with inj. Ketorolac (20mg) and 67 (50.76%) were treated with Inj. Nalbuphine (30mg) at 6 hourly intravenous doses. The average age distribution of this study was 40.52 15.03 years and the age and sex distribution of this study were homogenous. Patients were followed at 0, 1, 6, 12, 24, 32, and 48 hours. Paie was assessed with VAS and NRS. Other related parameter like pulse rate, respiratory rates, blood pressure, sedation score and adverse effects were also recorded at each follow up. This study revealed that both Ketorolac and Nalbuphine reduced the pain score(VAS and NRS) below 4′ within 12 hours and it gradually decreased more. Decrement of pain score with nalbuphine was significantly better than Ketorolac from 12 hours and onwards. Decrement of pulse rate, blood pressure, respiratory rate and sedation score also statistically favored Nalbuphine from 6-12 hours and onwards. Changes in diastolic blood pressure were proved null with Z test (p>0.05). No events of respiratory depression, bradycardia or shock were observed in any group. Therefore, this study clearly concludes that both inj. Nalbuphine(20mg) and inj. Ketorolac(30mg) can be used effectively in management of post-operative pain in orthopedics and Inj. Nalbuphine (20mg) is superior to Inj. Ketorolac(30mg) in this regard.
Key Words: Pulse rate, Blood pressure, Respiratory rare, Operative pain.