Abstract Background: Spinal anesthesia is a standard technique for Cesarean section due to its rapid onset and effective sensory and motor blockade. However, its limited postoperative analgesic duration often necessitates opioid adjuvants. This study aimed to evaluate and compare the analgesic efficacy and side effect profile of two doses of intrathecal nalbuphine when added to 0.5% hyperbaric bupivacaine. Materials and Methods: This prospective, randomized, double-blind controlled trial included 120 parturients undergoing elective Cesarean section under spinal anesthesia. Participants were randomly assigned into three groups ( n = 40 each): Group B received 10 mg hyperbaric bupivacaine with placebo; Group N1 received 10 mg bupivacaine + 1.6 mg nalbuphine; and Group N2 received 10 mg bupivacaine + 2.0 mg nalbuphine. The primary outcome was duration of postoperative analgesia. Secondary outcomes included onset and duration of sensory and motor block and incidence of adverse events. Results: Durations of postoperative analgesia and two-segment regression time were significantly prolonged in the nalbuphine groups (N1 and N2) compared to control ( P < 0.001). Group N2 demonstrated the longest duration of analgesia. Onset times of sensory and motor blocks were similar among all groups. The incidence of side effects such as nausea, vomiting, and hypotension was low and comparable across groups, with no cases of pruritus or respiratory depression observed. Conclusion: Intrathecal nalbuphine at 1.6 mg and 2.0 mg significantly enhances the duration of postoperative analgesia without increasing adverse effects. The 2.0-mg dose offers superior analgesic efficacy, making it a suitable adjuvant to bupivacaine in Cesarean section anesthesia. Further studies are needed to explore the ceiling effect and optimal dosing range.
Deetayart et al. (Tue,) studied this question.
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