Effect of intraperitoneal instillation of dexmedetomidine or fentanyl as adjuvants to bupivacaine on fast tracking discharge criteria in patients undergoing ambulatory laparoscopic cholecystectomy: a randomised double-blind control trial

Abstract Background Postoperative analgesia in laparoscopic cholecystectomy significantly affects the ambulation and discharge of the patient. This study compares fentanyl and dexmedetomidine as adjuvants to bupivacaine in intraperitoneal instillation after LC, in terms of their impact on ambulation, analgesic efficacy and recovery profile. Ninety patients were randomised into three groups with thirty patients in each group; group BF was administered 20 ml of 2 μg/kg fentanyl + 0.25% bupivacaine, group BD received 20 ml of 1μg/kg dexmedetomidine + 0.25% bupivacaine and group B received 20 ml of 0.25% bupivacaine only. After 8 h, Post-Anaesthesia Discharge Scoring System (PADS) scored for determining home readiness. Analgesic profile was assessed using Verbal Rating Scale and rescue analgesia requirement seen. Sedation was scored using Ramsay sedation scoring. Results Group B had significantly higher VRS and rescue analgesia requirements whilst groups BF and BD had a similar analgesic profile. Ramsay sedation scores were significantly higher in group BD when compared to groups BF and B. However, the PADS score remained comparable in all three groups (P = 0.113). The trial was retrospectively registered with the clinical trial registry of India CTRI/2019/07/020466. Conclusion Intraperitoneal instillation of bupivacaine in combination with dexmedetomidine or fentanyl significantly reduces postoperative pain scores in comparison to bupivacaine alone, in patients undergoing ambulatory laparoscopic cholecystectomy. However, fentanyl may be preferred over dexmedetomidine, because it causes less sedation and achieves a better PADS score.

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SP1.2.9To Evaluate the Analgesic Efficacy of Intraperitoneal Tramadol Vs Placebo for Post Operative Pain Relief Following Laparoscopic Cholecystectomy, A Double Blind Randomized Control Trial

British Journal of Surgery ◽

10.1093/bjs/znab361.019 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Siddhartha Handa ◽

MS Sangolli ◽

Sanjay Panchal

Keyword(s):

Adverse Effect ◽

Laparoscopic Cholecystectomy ◽

Pain Relief ◽

Adverse Effects ◽

Controlled Trial ◽

Analgesic Efficacy ◽

Double Blind ◽

Institutional Ethics ◽

Intraperitoneal Instillation ◽

The Mean

Abstract Aim To study the effectiveness of intraperitoneal instillation of tramadol for postoperative laparoscopic cholecystectomy (LC) pain relief and improve incidence of adverse effect. Methods Double blinded randomized controlled trial over 1 year. The Ethical Clearance was obtained from Institutional Ethics Committee. 60 patients scheduled for LC were enrolled in the study. Patients were randomly assigned into 2 groups using computer generated random numbers. Group T: Received intraperitoneal tramadol 100 mg (diluted in 20 mls distilled water). Group S: Received 20 ml of intraperitoneal normal saline. Pain was assessed using VAS. The assessment was done at 0, 15, 30, 60 minutes, 4, 8, 12, 16 and 24 hours. Incidence of adverse effect were observed. Results In group T, the mean pain scores at all the intervals were significantly low (p < 0.050) except at 24 hours (p = 0.210). Analgesia requirement was significantly high in group S compared to group T immediate post op, 15, 60 minutes, 8 and 12 hours (p < 0.050). The mean requirement of analgesia immediate post op, 15 minutes, 4 and 8 hours was significantly low in group T compared to group S (p < 0.050). 30% patients in group T did not require analgesia at all compared to S (p < 0.001). Incidence of adverse effects at 4 hours was 43% in group S compared to 40% in group T (p > 0.050). Conclusion Intraperitoneal instillation of tramadol in LC has beneficial effect in terms of postoperative pain relief following LC and lower requirement of analgesia. However, the incidence of adverse effects was comparable in both the groups.

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Effect of Nefopam-Based Patient-Controlled Analgesia with and without Fentanyl on Postoperative Pain Intensity in Patients Following Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Non-Inferiority Trial

Medicina ◽

10.3390/medicina57040316 ◽

2021 ◽

Vol 57 (4) ◽

pp. 316

Author(s):

Ki Tae Jung ◽

Keum Young So ◽

Seung Chul Kim ◽

Sang Hun Kim

Keyword(s):

Laparoscopic Cholecystectomy ◽

Adverse Effects ◽

Rating Scale ◽

Analgesic Efficacy ◽

Numeric Rating Scale ◽

Controlled Study ◽

Patient Controlled Analgesia ◽

Double Blind ◽

Randomized Controlled ◽

Lockout Interval

Background and Objectives: We investigated the non-inferiority of patient-controlled analgesia (PCA), using either nefopam alone or combined nefopam-fentanyl for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Materials and Methods: In this prospective, randomized, controlled study, 78 patients were allocated to receive nefopam 240 mg (Group N240) or nefopam 120 mg with fentanyl 600 μg (Group NF), equivalent to fentanyl 1200 μg, with a total PCA volume of 120 mL. Patients were given a loading dose (0.1 mL/kg) from the PCA device along with ramosetron (0.3 mg) and connected to a PCA device with a background infusion rate of 2 mL/h, bolus dose amount set at 2 mL, and lockout interval set at 15 min. Pain scores were obtained using the numeric rating scale (NRS) at 30 min after recovery room (RR) admission, as well as 8 and 24 h postoperatively. The primary outcome was analgesic efficacy evaluated using NRS-rated 8 h postoperatively. Other evaluated outcomes included the incidence rate of bolus demand, rescue analgesic and antiemetic requirements, and postoperative adverse effects. Results: NRS scores were not significantly different between the groups throughout the postoperative period (p = 0.539). NRS scores of group N240 were not inferior to those of group NF at 30 min after RR admission, or at 8 and 24 h postoperatively (mean difference [95% CI], −0.05 [−0.73 to 0.63], 0.10 [−0.29 to 0.50], and 0.28 [−0.06 to 0.62], respectively). Postoperative adverse effects were not significantly different between the two groups (p = 1.000) and other outcomes were also not significantly different between the two groups (p ≥ 0.225). Conclusions: PCA using nefopam alone has a non-inferior and effective analgesic efficacy and produces a lower incidence of postoperative adverse effects compared to a combination of fentanyl and nefopam after laparoscopic cholecystectomy.

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Effectiveness of Intravenous Dexmedetomidine vs. Fentanyl for Attenuation of Haemodynamic Response to Pneumoperitoneum in Laparoscopic Cholecystectomy: A Randomised Double Blind Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/44939.14106 ◽

2020 ◽

Author(s):

Reema Meena ◽

Chandrakant Parashar ◽

Priyanka Jain ◽

Manoj Soni

Keyword(s):

Laparoscopic Cholecystectomy ◽

Postoperative Analgesia ◽

Minimal Invasive ◽

Double Blind Study ◽

Double Blind ◽

Rescue Analgesia ◽

Haemodynamic Changes ◽

Group A ◽

American Society ◽

Group B

Introduction: Laparoscopy is a widely performed minimal invasive surgical procedure, wherein various haemodynamic changes are faced by anaesthesiologists during Pneumoperitoneum (PNP). Aim: To compare the effectiveness of dexmedetomidine vs fentanyl for attenuating the haemodynamics response to PNP in Laparoscopic Cholecystectomy (LC). Materials and Methods: A total of 84 patients of 18-50 years age, American Society of Anaesthesiologists (ASA) Class I/II of either sex for elective LC were included. The patients were divided into two groups (A, B) of 42 patients each. Group A received dexmedetomidine and Group B received fentanyl. Both the drugs were given as loading dose of one μg/kg over ten min followed by maintenance 0.2 μg/kg/h throughout the surgery. Haemodynamic parameters were recorded at different time intervals throughout the surgery. In recovery room patients were observed for postoperative analgesia by using Visual Analogue Scale (VAS), sedation level using RAMSAY Sedation score at every 30 minutes till the time of giving first rescue analgesia and side effects, if any. Results: Intraoperatively, throughout the period of PNP, Group A showed statistically better attenuation of haemodynamic responses in comparison to Group B (p<0.05). After creating PNP, rise in Mean Arterial Pressure (MAP) was observed in both group A and group B, 99.38±6.32 and 103.43±9.81, respectively but this rise was more in group B which was statistically significant (p<0.05) throughout the surgery except 40 minutes after PNP creation. Time to first rescue analgesia or mean duration of postoperative analgesia (VAS>3) was significantly longer in dexmedetomidine group (102.14±32.50 minutes) than fentanyl group (42.86±15.03 minutes). There was better control of pain but more sedation in Group A than in Group B. Conclusion: This study concludes that intravenously administered dexmedetomidine shows better attenuation of haemodynamic responses to CO2 insufflation as compared to fentanyl. Dexmedetomidine also provides better sedation and has more analgesic sparing effect.

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Role of intraperitoneal instillation of bupivacaine after laparoscopic cholecystectomy for post-operative pain management: a randomized controlled trial

International Surgery Journal ◽

10.18203/2349-2902.isj20203986 ◽

2020 ◽

Vol 7 (10) ◽

pp. 3239

Author(s):

Pramatha Nath Datta ◽

Arijit Roy

Keyword(s):

Laparoscopic Cholecystectomy ◽

Pain Management ◽

Hospital Stay ◽

Rating Scale ◽

Length Of Hospital Stay ◽

Control Group ◽

Rescue Analgesia ◽

Group A ◽

Group B

Background: Intra peritoneal (IP) local anaesthesia (LA) is a simple, cheap and safest method of providing post-operative (post-op) analgesia after laparoscopic cholecystectomy (LC). In this research, the role of intraperitoneal (IP) instillation of bupivacaine on post-op pain was studied. Post-op pain at 6, 12 and 24 hours was assessed using numeric rating scale. The degree of ambulation postoperatively at 6 and 24 hours and the requirement of analgesics was taken into account. The length of hospital stay was also a factor.Methods: A total of 76 patients during January 2018 to December 2018, undergoing LC, fitting the inclusion criteria were included randomly and divided in to two groups, bupivacaine group (B) and control group (A) based on a pre-generated random number sequence by the principal investigator. The surgical outcome was compared based on multiple parameters and the primary outcome measures were the post-op pain and analgesic requirement.Results: Degree of ambulation at 6 hours was significantly better in group B, compared to group A (p=0.008). The requirement of first dose of rescue analgesia was found to be within 6 hours (post-op) in 34 patients of group A (89.47%) as compared to 13 patients of group B (34.21%), was found to be statistically significant (p<0.001). There was statistically significant (p=0.002) difference with respect to length of hospital stay between the two groups.Conclusions: In our study we found that IP bupivacaine (0.5%) is an effective, economical, safe method of post-op pain management with better post-op recovery.

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The Optimizing Background Infusion Mode Decreases Intravenous Patient-Controlled Analgesic Volume Compared to Fixed-Rate Background Infusion in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Controlled, Double-Blind Study

10.20944/preprints202012.0305.v1 ◽

2020 ◽

Author(s):

Ki Tae Jung ◽

Keum Young So ◽

Seung Un Kim ◽

Sang Hun Kim

Keyword(s):

Laparoscopic Cholecystectomy ◽

Infusion Rate ◽

Rating Scale ◽

Analgesic Efficacy ◽

Blind Study ◽

Double Blind Study ◽

Fixed Rate ◽

Double Blind ◽

Randomized Controlled ◽

Background Infusion

Background and objectives: Traditional intravenous, patient-controlled analgesia (PCA) uses a fixed-rate continuous background infusion mode. However, some patients suffer from inadequate analgesia or opioid-related adverse effects due to the biphasic pattern of postoperative pain. Therefore, we investigated the postoperative analgesic efficacy of PCA using an optimizing background infusion mode (OBIM), where the background injection rate varies depending on the patient's bolus demand. Materials and Methods: We prospectively enrolled 204 patients who underwent laparoscopic cholecystectomy in a randomized, controlled, double-blind study. Patients were allocated into either the optimizing (group OBIM) or the traditional background infusion group (group TBIM). The numeric rating scale (NRS) score for pain was evaluated at admission to and discharge from the recovery room, as well as at the 6th, 24th, and 48th postoperative hours. Data of bolus demand count, total infused volume, and background infusion rate was downloaded from the PCA device at 30-min intervals until the 48th postoperative hour. Results: The NRS score was not significantly different between groups throughout the postoperative period (P = 0.621), decreasing with time in both groups (P < 0.001). The bolus demand count was not significantly different between groups throughout (P = 0.756). The mean cumulative infused PCA volume was lower in group OBIM [84.0 (95% confidence interval: 78.9−89.1) mL) than in group TBIM [102 (97.8−106.0) mL] (P < 0.001). The background infusion rate was significantly different between groups throughout (P < 0.001); it was higher in group OBIM than in group TBIM before the 12th postoperative hour, and lower from the 18th to the 48th postoperative hours. Conclusions: The OBIM combined with bolus dosing is useful in that it reduces the cumulative PCA volume compared to the TBIM combined with bolus dosing, while yielding comparable postoperative analgesia and bolus demand in patients undergoing laparoscopic cholecystectomy.

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Pregabalin As A Premedicant To Attenuate Pressor Response In Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Double-Blind, Placebo-Controlled Study

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i3.2480 ◽

2020 ◽

Vol 11 (3) ◽

pp. 3418-3423

Author(s):

Sweety Agrawal ◽

Shubdha Bhagat ◽

Pratibha Deshmukh ◽

Amol Singham

Keyword(s):

Laparoscopic Cholecystectomy ◽

Pressor Response ◽

Controlled Study ◽

Double Blind ◽

Co2 Insufflation ◽

Ramsay Sedation Scale ◽

Minute Interval ◽

Group A ◽

Group B ◽

Induction Of Anaesthesia

The present study was done to evaluate the ability of oral pregabalin to attenuate the pressor response to airway instrumentation in patients undergoing laparoscopic cholecystectomy under general anesthesia. Sixty-four adult patients aged between 25-55 year of either gender belonging to ASA-1 or ASA2 physical status weighing 50-70 kg were enrolled in this study. Thirty-two patients each were randomized to group A, or group B. Patients in group A received tablet Pregabalin (150mg) and those in group B received placebo orally one hour before induction of anaesthesia. Heart rate, blood pressure, and sedation were assessed preoperatively before giving the tablets and after 30 minutes, and just before induction of anaesthesia. Intraoperative, pulse rate, mean arterial pressure, ECG in the lead II, SPO2 and ETCO2 were monitored. All the above parameters were noted during laryngoscopy and intubation, 3 minutes after CO2 insufflation, and then at every 10-minute interval till the end of surgery. These parameters were also recorded after extubating the patient. The Ramsay sedation scale was used to assess the sedation at the baseline, one hour after drug intake , one hour after extubation and 4 hour after surgery. Any adverse effects in the postoperative period were recorded. The result of our study shows that pre-emptive administration of oral pregabalin 150 mg significantly reduced the pressor response at the time of laryngoscopy and intubation, after CO2 insufflation and just after extubation. We conclude that oral pregabalin premedication is effective in successful attenuation of hemodynamic pressor response to laryngoscopy, intubation and pneumoperitoneum in patients undergoing laparoscopic cholecystectomy

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Effects of Dexmedetomidine on Intraoperative Hemodynamic Responses in Patients Undergoing Laparoscopic Cholecystectomy: A Randomised Double Blind Trial

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v7i4.7629 ◽

2021 ◽

Author(s):

Dhanashree Dongare ◽

Smita Gharde

Keyword(s):

Laparoscopic Cholecystectomy ◽

Base Line ◽

Loading Dose ◽

Double Blind Trial ◽

Hemodynamic Responses ◽

Double Blind ◽

Significant Difference ◽

Group A ◽

American Society ◽

Group B

Background: Dexmedetomidine is selective alpha 2 agonist with sedative sympatholytic, analgesic properties and is used as an anaesthetic adjuvant. We have evaluated the effect of dexmedetomidine on various hemodynamic responses to incidences such as laryngoscopy, endotracheal intubation, exubation and pneumoperitoneum in patients who were undergoing surgeries like laparoscopic cholecystectomy. We have used loading dose of 0.5mcg/kg of inj. Dexmedetomidine given over 10 minutes followed by infusion of a dose of 0.3mcg/kg/hour for the control of hemodynamic response to laparoscopy. Methods: Patient of either sex aged between 18-50 yrs, belongs to ASA I and II (AMERICAN SOCIETY OF ANAESTHESIOLOGY) posted for laparoscopic cholecystectomy were included. Institutional ethical committee clearance was obtained prior to study. After enrolment and valid written consent was taken. 60 patients were enrolled written valid informed consent was taken. Patients were divided into two groups 30 each with computerized randomization. Base line parameters were noted. Observer and patient was blinded for the content of syringe. Group A received injection dexmedetomidine and group B received bolus and infusion of normal saline at same rate. Routine general anaesthesia was instituted. Parameters were noted after induction, after intubation, after co2 insufflation, after 20 min, after 40 min, after co2 deflation, after extubation, after 1 and 2 hrs post-extubation. Results: Group A showed significantly less rise in HR and MAP than Group B. Requirement of intraoperative propofol was more in Group B. There was no significant difference for time taken to awakening in both groups. Conclusion: We found Injection Dexmedetomidine in given doses gave good hemodynamic control with minimal undesired effects during laparoscopy.

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Epidural butorphanol for post operative analgesia in lower limb surgeries: A comparative study with epidural tramadol

Journal of Chitwan Medical College ◽

10.3126/jcmc.v6i3.16696 ◽

2017 ◽

Vol 6 (3) ◽

pp. 26-32

Author(s):

G P Deo ◽

S K Shrestha ◽

I N Shrestha

Keyword(s):

Patient Satisfaction ◽

Side Effects ◽

Lower Limb ◽

Analgesic Efficacy ◽

Epidural Injection ◽

Double Blind ◽

Duration Of Action ◽

Number Of Patients ◽

Group B

To compare the efficacy of epidural butorphanol and tramadol for post operative analgesia in lower limb surgeries. Randomized, controlled, double blind, prospective study conducted at Department of Anaesthesia and Critical Care, Chitwan Medical College from September 1st 2015 to August 31st 2016. 60 patients of ASA Grade I and II of either sex, aged between 18-65 years willing for epidural analgesia for post operative analgesia were included in the study. They were divided into two groups: Group B- Butorphanol group and Group T- Tramadol group. Subjects of Group B received 2mg of Butorphanol and 0.25% Bupivacaine making a total volume of 10 ml and that of Group T received 100mg of Tramadol and 0.25% Bupivacaine also making a total volume of 10 ml. Analgesic efficacy was assessed by Visual Analogue Scale (VAS). The onset and duration of analgesia along with side effects were also assessed. The quality of analgesia was studied using time to independent mobilization and overall patient satisfaction. Total number of patients was 60, of ASA Grade I and II, aged between 18-65 years. The mean age of patients in Group B was 42.6±11.7 years and 46.1±11.2 years in Group T. Time of onset of analgesia after epidural injection was 7.4±0.9 minutes in Group B and 12.7±1.5 minutes in Group T and the difference was found to be statistically significant. Duration of analgesia was 317.1±99.1 minutes and 438.8±136.6 minutes in Butorphanol and Tramadol groups respectively which was also statistically significant. Sedation was significantly higher in butorphanol group whereas nausea and vomiting was higher in tramadol group. Quality of analgesia in terms of patient satisfaction was better with epidural butorphanol. Both epidural tramadol and butorphanol were effective in relieving post operative pain however butorphanol had lesser side effects and greater patient satisfaction compared to tramadol but the duration of action was relatively short.

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A COMPARATIVE STUDY OF CLONIDINE VERSUS NALBUPHINE AS INTRATHECAL ADJUVANTS TO 0.5% HYPERBARIC BUPIVACAINE DURING LOWER ABDOMINAL SURGERIES – A RANDOMIZED DOUBLE BLIND INTERVENTIONAL STUDY.

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i3.1004 ◽

2020 ◽

Vol 4 (3) ◽

Author(s):

Trishala Jain ◽

Jaipal .

Keyword(s):

Motor Block ◽

Sensory Block ◽

Double Blind Study ◽

Hyperbaric Bupivacaine ◽

Double Blind ◽

Rescue Analgesia ◽

Institutional Ethics ◽

Group A ◽

Group B ◽

Intrathecal Clonidine

Background: Regional anesthesia techniques for gynecological procedures are on increasing trends due to their advantage of postoperative analgesia owing to intrathecal adjuvants. The present study was aimed to comparatively evaluate the clinical efficacy of clonidine with nalbuphine when co-administered intrathecally with 0.5% hyperbaric bupivacaine for Lower abdominal surgeries in Gynecology. Methods: With institutional ethics committee clearance No. 193MC/EC/2018, randomized, double blind study was conducted. After obtaining informed written consent total of 84 patients scheduled for lower abdominal surgeries were randomly allocated into two groups: Group A (n=42) - Inj. 3.5 ml Bupivacaine 0.5% + 0.2 ml Clonidine(30µg) intrathecally. Group B (n=42) - Inj.3.5 ml Bupivacaine 0.5%+0.2 ml Nalbuphine(2mg) intrathecally. The characteristics of sensory and motor block, hemodynamic data, side effects were recorded. Results: The onset of sensory block was earlier in Group B than Group A (3.08±0.52 min vs 4.00±0.54 min, p<0.001 ). The onset of motor block was also earlier in Group B than Group A (7.78±0.80 min vs 8.80±0.95min, p<0.001). The time to first rescue analgesia in patients receiving intrathecal clonidine was significantly delayed than patients receiving intrathecal nalbuphine (284.95 ± 12.93 min vs 211.52 ± 15.92 min, p<0.001). Introperative hemodynamic changes were comparable and none of the patient suffered from respiratory depression except very little cases of shivering which are not significant. Conclusions: Intrathecal clonidine as adjuvant to bupivacaine provided was clinically more effective than nalbuphine for prolonging the duration of analgesia for gynecological procedures. Keywords: Bupivacaine, Clonidine, Lower abdominal surgeries in gynecology, Nalbuphine, Subarachnoid block.

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Tramadol or Nalbuphine; Which One is Superior for Analgesia in Post-Operative Period after Percutaneous Nephrolithotomy

Annals of Punjab Medical College ◽

10.29054/apmc/2021.1062 ◽

2021 ◽

Vol 15 (1) ◽

pp. 51-54

Author(s):

Muhammad Sheraz Javed ◽

◽

Ghulam Mehboob Subhani ◽

Muhammad Akmal ◽

Muhammad Irfan Munir ◽

...

Keyword(s):

Pain Control ◽

Rating Scale ◽

Randomized Study ◽

Rescue Analgesia ◽

Post Operative Period ◽

High Prevalence ◽

Group A ◽

Group B ◽

Medical University ◽

Pain Rating Scale

Background: Kidney stones has got high prevalence worldwide especially in our part of world and per-cutaneous nephrolithotomy (PCNL) is gold standard operative modality for renal stone management. Pain control after PCNL is the most important task for treating surgeon as effective pain control causes smooth patient recovery in post-operative period. For analgesia, many drugs can be used, out of which tramadol and nalbuphine always been in comparison for effective analgesic activity. Objective: To compare efficacy of tramadol and nalbuphine as potent analgesic in patients after PCNL. Study Design: A prospective randomized study. Settings: Department of Urology and Kidney Transplantation, Allied Hospital/Faisalabad Medical University, Faisalabad and Department of Urology, DHQ Hospital/Faisalabad Medical University, Faisalabad Pakistan. Duration: From September 2016 to September 2020 (4 Years). Methodology: 286 patients undergoing PCNL for either gender and sides enrolled in study according to inclusion and exclusion criteria. Patients divided into Group A (Administered with tramadol) and Group B (administered with nalbuphine) and patients evaluated for pain up to 48 hours after surgery using 11-point numerical pain rating scale rating from0-10 where 0 is no pain, 1-3 mild pain, 4-6 moderate pain, 7-9 severe pain and 10 as worst pain and use of rescue analgesia observed in either groups. Data obtained and statistical evaluation done. Results: 286 patients enrolled from age 15-75 years with mean age of 40.2 years. Among 286 patients, 161 were male and 125 were female patients. Both groups A and B having 143 patients each. Analysis showed that tramadol has superiority over nalbuphine and need of analgesia is more in patient given nalbuphine (118 vs 31) as maintenance analgesic agent in post-operative period after PCNL. Conclusion: This study showed that tramadol has superiority over nalbuphine for analgesia after PCNL.

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