Spinal nalbuphine in anorectal surgery - Trial PACTR201612001903142

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Summary

There is no doubt that intrathecal opioids have been used for subarachnoid block with or without local anesthetic to allow complete analgesia during surgical procedures. However their use is limited for fear of their side effects specially respiratory depression . Morphine is the standard opioid medication used for intra and postoperative analgesia . But owing to its associated adverse effects including (respiratory depression , nausea , vomiting constipation , pruritis and urine retention) its use is limited . (1)Various agents have been searched to replace morphine . Optimization of the dose of spinal narcotics is vital to avoid unpleasant side effects. Nalbuphine which is a mixed agonist antagonist ' being kappa agonist and mu antagonist can be preferred due to less respiratory depression and vomiting than morphine . Also It can mimic morphine in its analgesic duration if used with optimal dose .Nalbuphine,on the other hand, being mu antagonist and kappa agonist ,has a ceiling effect in its respiratory depression [2,3];hence it is considered to be safer than morphine. Many studies have reported that the incidence of adverse effects like pruritus and PONV is lower with nalbuphine in comparison with morphine [4, 5]. One study concluded that the optimal dose of nalbuphie is 0.8 mg in surgery while another one concluded that it is 1.6 mg in lower limb surgery . We hypotheses that higher doses of nalbuphine can improve markedly duration of analgesia with insignificant side effect profile.

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