Randomized Comparison Of Tramadol, Nalbuphine And Fentanyl Used As Premedication In Attenuation Of Hemodynamic Response To Laryngoscopy And Postoperative Pain In Laparoscopic Cholecystecyomy

Background: Stress response to laryngoscopy during endotracheal intubation and pain after surgeries under General Anesthesia are one of the major concern and challenge for anesthetists. A number of methods have been used to modify the laryngoscopy and endotracheal intubation response, including different intubation devices, beta blockers, vasodilators and opioids. Opioids are good analgesics and have role in attenuation of stress response to laryngoscopy when used in premedication prior to laryngoscopy. Our aim of study is to compare the efficacy and safety of three opioids ie; Tramadol, Nalbuphine and Fentanyl as stress buster and analgesic when used in single dose as premedication in General Anaesthesia for Laparoscopic Cholecystectomy. Methods: One twenty patients of ASA grade I&II were randomly selected with forty patients in each group. Drug was given 10 min before starting the anaesthesia. Patients were assessed for change in hemodynamic parameter from baseline in Immediate post intubation (IPI), 1, 2 and 5min post intubation to note the stress response to laryngoscopy. Intra operative vitals were recorded for every 15min till end of surgery and in immediate and 5min post extubation period. VAS was recorded after awakening from anaesthesia. Any adverse reaction like nausea vomiting, respiratory depression and sedation were also recorded. Results: Nalbuphine and Fentanyl were found to be better drug compared to Tramadol for attenuation of hemodynamic response to Laryngoscopy (p<0.0001). No significant difference in hemodynamics was found intraoperatively in all the three drugs. Nalbuphine and Tramadol were having good analgesia in immediate post operative period. Mild respiratory depression and sedation was reported with Nalbuphine. Nausea vomiting was significantly high with Tramadol (p<0.001). Conclusion: Nalbuphine is one of the better choices for relieving stress to laryngoscopy and intubation, maintaining good hemodynamics intraoperatively and providing pain relief in immediate postoperative period.