THE ADDITIONAL REQUIREMENT OF NALBUPHINE AS RESCUE ANALGESIC ALONG WITH PARACETAMOL AND KETOROLAC IN PAIN MANAGEMENT OF PATIENTS UNDERGOING ELECTIVE CESAREAN SECTION IN FIRST 24 HOURS

Abstract

Background: Nalbuphine can be used as a supplement for obstetrical analgesia during labour and delivery. Paracetamol is the drug of choice in patients that cannot be treated with non-steroidal anti-inflammatory drugs (NSAID). Ketorolac has advantages over narcotic analgesics. The aim of our study was to evaluating the requirement of nalbuphine along with paracetamol and ketorolac in post-operative cesarean patient.

Objective: To determine the additional requirement of Nalbuphine as a rescue analgesic along with Paracetamol and Ketorolac in postoperative pain management of patients undergoing elective cesarean section in first 24 hours.

Material and Methods: This descriptive study was conducted in the Department of Anesthesia at Liaquat National Hospital and Medical College, Karachi, from January 2025 to April 2025. Total 139 female patients were included. Pain assessment was conducted using the Visual Analogue Scale (VAS). Nalbuphine was administered upon reaching VAS score above 4. Postoperative analgesia protocols consisted of intravenous Paracetamol and Ketorolac. Pain severity was assessed at specific intervals following surgery. The Chi-square test and Repeated Measure ANOVA were applied for analysis.

Results: The mean age was 29.78±5.16 years. The need for rescue analgesia was highest at 0 hour (30.2%) and no additional requirement at 24 hours. A significant variation in pain scores over time (p<0.001) was observed. A statistically significant association between diabetes and hypertension with rescue analgesia requirement at 0 hours (p=0.044 and p=0.050, respectively) was also observed.

Conclusion: This pain intensity fluctuated significantly between different time points, peaking at 6 hours. The highest need for rescue analgesia at 0 hours and none at 24 hours.