What question did this study set out to answer?

To evaluate the impact of nalbuphine and morphine on the analgesic duration of bupivacaine in a supraclavicular block.

January 10, 2026BMC Anesthesiology0 citationsOpen Access

Effect of nalbuphine and morphine as adjuvants to bupivacaine in ultrasound-guided supraclavicular block: a randomized controlled trial with machine learning-based predictive analysis

Q: What does this research mean for the field?

Nalbuphine and morphine significantly prolong the analgesic duration of bupivacaine in patients undergoing supraclavicular brachial plexus block. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

AAAlzahraa AbbasAl-Azhar University SGSameh H. GhoneimAl-Azhar University МШМ ШарфBen-Gurion University of the Negev

Key Result

Nalbuphine and morphine significantly prolonged the analgesic duration of bupivacaine in patients undergoing supraclavicular brachial plexus block.

Key Points

To evaluate the impact of nalbuphine and morphine on the analgesic duration of bupivacaine in a supraclavicular block.
Conducted a prospective randomized controlled trial on 60 patients.
Divided patients into three groups: Control, Nalbuphine, and Morphine.
Recorded analgesic duration, sensory and motor block onset, and postoperative analgesic use.
Developed a K-Nearest Neighbor ML model to predict analgesic duration based on demographic and hemodynamic parameters.
Nalbuphine and morphine significantly prolonged analgesic duration compared to the control group.
The KNN model showed a strong correlation (R = 0.95) between observed and predicted analgesic duration.
Both adjuvants enhanced the efficacy of bupivacaine in the supraclavicular block.

Structured PICO

Does the addition of nalbuphine or morphine to bupivacaine prolong the duration of analgesia in patients undergoing upper limb surgeries under supraclavicular brachial plexus block?

Population

60 adult patients aged 21 to 60 years, ASA physical status I or II, scheduled for elective surgeries of the upper limb distal to the elbow.

Intervention

Nalbuphine (50 µg/kg) or Morphine (50 µg/kg) added to 25 ml of 0.5% bupivacaine in a single injection for ultrasound-guided supraclavicular brachial plexus block.

Comparator

Control group receiving 25 ml of 0.5% bupivacaine plus 5 ml saline.

Outcome

Duration of analgesia, measured from block administration to first postoperative analgesic request.patient reported

The addition of nalbuphine or morphine to bupivacaine significantly prolongs analgesic duration in supraclavicular brachial plexus blocks, and machine learning models like KNN can accurately predict this duration.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Supraclavicular brachial plexus block is a commonly used regional anesthesia technique for upper extremity surgeries. The addition of adjuvants to local anesthetics enhances the duration and quality of anesthesia. Recently, Machine Learning (ML) has emerged as a tool for predictive modeling in medicine, including pain management. This study investigates the predictive capability of a K-Nearest Neighbor (KNN) ML model for analgesic duration using different drug combinations. A prospective randomized controlled trial was conducted on 60 patients scheduled for upper limb surgeries under ultrasound-guided supraclavicular brachial plexus block. Patients were divided into three groups: Control (bupivacaine + saline), Nalbuphine (bupivacaine + nalbuphine), and Morphine (bupivacaine + morphine). The analgesic duration, sensory and motor block onset and duration, and postoperative analgesic use were recorded. A ML model, K-Nearest Neighbor (KNN), was developed to predict analgesic time based on demographic and hemodynamic parameters. Both nalbuphine and morphine significantly prolonged the duration of analgesia compared to the control group. The KNN model demonstrated a strong correlation ( R = 0.95) between the observed and predicted analgesic duration, indicating high predictive accuracy. Nalbuphine and morphine significantly extended the analgesic duration of bupivacaine in ultrasound-guided supraclavicular brachial plexus block. ML models, such as KNN, offer effective tools for predicting analgesic outcomes and can assist anesthesiologists in making informed decisions regarding drug combinations for enhanced patient care. ClinicalTrials.gov (NCT07008443). Registered in June 2025. Retrospectively registered. ClinicalTrials.gov is a primary registry in the WHO International Clinical Trials Registry Platform (ICTRP) network.

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