Comparison of Ketamine, Nelbuphin, and Ondansetron as Adjuncts in Bier’s block.


  • Samina Aslam Abwa Medical College, Faisalabad.
  • Humaira Ahmad Faisalabad Medical University. Faisalabad.
  • Muhammad Rauf Independent Medical University, Faisalabad.



Nelbuphin, Ondansetron


Objective: To find out the better adjunct in bier’s block. Study Design: Comparative, Qualitative. Setting: Aziz Fatima Hospital and Faisal Hospital. Period: August 2021 to May 2022. Material & Methods: This study was carried out in Faisal Hospital and Aziz Fatima Hospital Faisalabad. Patients electively undergoing hand and forearm surgery with expected duration less than or equal to one hour had been selected and randomly divided in three groups, group 1 LK means lignocaine and ketamine, group 2 LN means lignocaine and nalbuphine and group 3 LO that is lignocain and ondeansetron. All patients selected were ASA 1,2 between 22 to 60 yrs of age. An informed consent was taken. Patients were monitored with standard non-invasive monitoring like pulse oximeter, NIBP and ECG. Onset of sensory block was assessed by pin prick and motor by movement at 0, 1, 2 minutes of drug given. Pain was assessed by using Numeric Rating Scale (NRS 0-10) Post-operative pain as well as systemic effects of drugs administered at 10,20,30 and 60 minutes recorded. Patients then shifted to parent ward and need for systemic analgesia recorded for 24 hours. Results: Ketamine is more effective drug in terms of providing longer duration and improving quality of anesthesia with little side effects. Conclusion: The results of this study showed that ketamine is a better adjunct in Bier,s block as compared to nelbuphine and ondansetron. The least effective drug is ondansetron in terms of prolonging duration of anesthesia and post operative analgesia. But all three do not have many systemic side effects.

Author Biographies

Samina Aslam, Abwa Medical College, Faisalabad.

MBBS, FCPS, MSc, Associate Professor Anesthesia, ICU, Pain Management, 

Humaira Ahmad, Faisalabad Medical University. Faisalabad.

MBBS, FCPS, Associate Professor Anesthesia, ICU, Pain Management, 

Muhammad Rauf, Independent Medical University, Faisalabad.

MBBS, MCPS, Associate Professor Anesthesia & ICU,