The analgesic efficacy of subcutaneous nalbuphine compared with epidural analgesia in abdominal surgeries: A randomized controlled trial

Background: Analgesia represents a cornerstone for the perioperative management of patients undergoing open abdominal surgery. Epidural analgesia (EPA) is a standard method for pain control in 50%-60% of major abdominal surgeries. Nalbuphine -a synthetic opioid agonist/ antagonist- has equianalgesic properties to morphine but without the undesirable side effects of the pure agonists. Objective: We compared the perioperative analgesic efficacy of subcutaneous nalbuphine and epidural analgesia in abdominal surgeries. Methods: 130 adult patients of both sexes with American Society of Anesthesiologists physical status class I or II aged 20-60 years were randomized into two equal groups. After induction of general anesthesia, the epidural was activated with 18 ml of bupivacaine 0.25% + 2 ml fentanyl (100 Mcg) in group (I), while in a group (II) subcutaneous nalbuphine (0.15 mg/kg) was injected. The time for the first postoperative analgesic request was recorded as the primary endpoint. The cumulative analgesics consumption within the first 24 postoperative hours and drug-related side effects were the secondary outcomes. Results: The time for the first postoperative analgesia request was significantly longer in group II than in group I (10.8 ± 1.34 vs 3.29 ± 0.72 hours) (p < 0.05). There was a significant reduction in postoperative analgesic requirements in group II compared with group I. Group II patients had significantly more sedation levels than group I (p < 0.05). Conclusion: Under the conditions of this study, subcutaneous nalbuphine showed a superior analgesic profile than epidural analgesia for open abdominal surgeries.