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January 1, 2023Revista Chilena de AnestesiaOpen Access

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

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Key result

Subcutaneous nalbuphine delays first analgesic request by ~7.5 hours vs epidural analgesia after abdominal surgery.

  • P<0.001
  • n=130

Why the study?

Epidural analgesia is standard for pain control in major abdominal surgeries, but nalbuphine may offer effective analgesia with fewer side effects.

Does subcutaneous nalbuphine delay the time for the first postoperative analgesic request compared to epidural analgesia in adults undergoing open abdominal surgery?

Population

130 adult patients ASA class I or II aged 20-60 years undergoing open abdominal surgery

Comparison

Subcutaneous nalbuphine (0.15 mg/kg) vs epidural analgesia with bupivacaine 0.25% + fentanyl 100 mcg

Design

Randomized controlled trial, single-blind, two equal groups

Follow-up

24 postoperative hours

Authors

NANoha A. AfifyKGKhaled M. Gaballah

Discussion

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Overview

Supports subcutaneous nalbuphine over epidural for prolonged postoperative analgesia in open abdominal surgery; extends randomized options beyond neuraxial routes.

Study Design

Type

RCT (n=130)

Blinding

Single-blind

Randomization

1:1 using a computerized software program

Multicenter

No

Structured PICO

Does subcutaneous nalbuphine delay the time for the first postoperative analgesic request compared to epidural analgesia in adults undergoing open abdominal surgery?

P
Population
130 adult patients aged 20-60 years with ASA physical status I or II undergoing elective open abdominal surgeries, followed for 24 hours postoperatively.
I
Intervention
Subcutaneous nalbuphine (0.15 mg/kg) injected after induction of general anesthesia
C
Comparator
Epidural analgesia activated with 18 ml of bupivacaine 0.25% + 2 ml fentanyl (100 Mcg) after induction of general anesthesia
O
Outcome
Time for the first postoperative analgesic requestpatient reported

Main Result

Absolute Event Rate: 10.8% vs 3.29%

p-value: p=<0.001

Subcutaneous nalbuphine provides a longer duration of postoperative analgesia and reduces analgesic requirements compared to epidural analgesia in open abdominal surgeries, though with increased sedation.

Limitations

  • Single-center trial
  • Single-blinded study (only in the operating room)
  • Exclusion of patients with ASA physical status classes > II limits external validity
  • Did not assess the level of sensory block in epidural group patients after catheter insertion
  • Did not use patient-controlled analgesia techniques due to limited resources

Cite This Study

Afify et al. (2023) conducted an RCT in Open abdominal surgery (n=130). Subcutaneous nalbuphine vs. Epidural analgesia (18 ml of bupivacaine 0.25% + 100 mcg fentanyl) was evaluated on Time for the first postoperative analgesic request after recovery (p=<0.001). Subcutaneous nalbuphine significantly prolonged the time to first postoperative analgesic request compared to epidural analgesia (10.8 vs 3.29 hours, p<0.001) in patients undergoing open abdominal surgery.

synapsesocial.com/papers/6aaba726dec6679171c53ffbhttps://doi.org/10.25237/revchilanestv52n6-08
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Also Consider

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