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In a prospective randomized double‑blind trial, 69 patients undergoing lower limb orthopedic surgery received epidural bupivacaine with either nalbuphine 10 mg, dexmedetomidine 100 μg, or saline. Dexmedetomidine provided the fastest onset (12.2 min) and longest duration of postoperative analgesia (365.9 min), followed by nalbuphine (318.4 min) and control (241.3 min). Patient satisfaction was highest with dexmedetomidine, which also reduced top‑up analgesic requirements. Both adjuvants were effective, but dexmedetomidine was superior.
Fig. 1 Flow chart of patients in the study groups. (Farmawy MSE, et al., 2023)
References
A Cochrane systematic review of 10 RCTs (658 children) found low‑quality evidence that nalbuphine reduces moderate/severe postoperative pain compared with placebo (RR 0.1 at 1 hour) and may reduce rescue analgesic requirements. Comparisons with morphine, tramadol, and pethidine were inconclusive due to wide confidence intervals. Postoperative nausea and vomiting did not differ significantly from placebo or morphine. The authors conclude that evidence is insufficient to definitively establish nalbuphine’s efficacy or superiority over other opioids in children.
Fig. 2 Comparison 1 Nalbuphine versus placebo, Outcome 1 Number of patients with moderate/severe pain (1h postop). (Schnabel A, et al., 2014)
References
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