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Effect of fentanyl and nalbuphine for prevention of etomidate-induced myoclonus

 Department of Anaesthesiology and Pain Management, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India

Correspondence Address:
Abhimanyu Singh Pokhriyal,
Department of Anaesthesiology and Pain Management, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0259-1162.251860

Background: Etomidate is a potent intravenous inducing agent with known undesirable side effects such as myoclonus and pain on injection in nonpremedicated patients. Aims: The aim of this study is to compare the effect of fentanyl and nalbuphine in the prevention of etomidate-induced myoclonus. Settings and Design: Randomized double-blind, placebo-controlled, and prospective comparative study. Materials and Methods: A total of 120 patients were randomly allocated to one of the three groups containing 40 patients each for intravenous administration of fentanyl 2 μg/kg diluted in 10 mL normal saline (NS) (Group 1), nalbuphine 0.3 mg/kg diluted in 10 mL NS (Group 2), and only 10 mL NS (Group 3) over 10 min. All groups subsequently received 0.3 mg/kg etomidate by intravenous bolus injection over 15–20 s and were assessed for the severity of pain using Grade IV pain scale and observed for myoclonus for 2 min and graded according to clinical severity. Serum creatinine phosphokinase (CPK) levels were obtained prior and postetomidate injection. Statistical Analysis: Statistical analysis was performed by the SPSS program version 17.0 for Windows. Tests used are Shaipro–Wilk test, ANOVA, Tukey's multiple comparison test, Tamhane's T2, and the Chi-square test. For all statistical tests,P < 0.05 was considered statistically significant with 5% level of significance (α). Results: The incidence of myoclonus in Group 1 and 2 was 52.5% and 17.5%, respectively, whereas it was 92.45% in Group 3. There was no pain observed in 70%, 92.5%, and 50% of patients in Group 1, 2, and 3, respectively. There was a statistically significant difference in mean CPK level after induction among three groups (P < 0.001). Conclusion: Nalbuphine is more effective than fentanyl in the prevention of etomidate-induced myoclonus and pain with the minimum rise in CPK levels.

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    -  Pokhriyal AS
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