Nalbuphine as an Intrathecal Adjuvant: a Minireview
Keywords:
nalbuphine, intrathecal adjuvant, spinal anesthesia, opioid agonist-antagonistAbstract
The use of nalbuphine, a mixed opioid agonist-antagonist, as an intrathecal adjuvant has garnered significant attention in recent years. Its role in enhancing analgesic efficacy, prolonging the duration of spinal anesthesia, and reducing opioid-related side effects presents a promising alternative in clinical anesthesia practice. This review article explores the pharmacological properties of nalbuphine, its mechanisms of action, and its clinical applications as an intrathecal adjuvant. Additionally, we evaluate the outcomes, safety profile, and limitations based on existing literature to provide a comprehensive understanding of its utility.
References
Amornyotin S. Nalbuphine: pharmacology revisited. Thai J Anesthesiol. 2025;51:73-6.
Shah MS, Masoodi T, Hussain SY, Jain D. Nalbuphine as an intrathecal adjuvant to 0.5% hyperbaric bupivacaine in two different doses for postoperative analgesia after abdominal hysterectomy: a prospective, randomized, double-blind control study. Cureus. 2022;14:e25044.
Deori KC, Taye MK, Lahkar B. Comparative study on regression time of block and adverse effects of nalbuphine and fentanyl as an adjuvant to intrathecal bupivacaine: a prospective randomized double-blind study. Ain-Shams J Anesthesiol. 2023;15:83.
Culebras X, Gaggero G, Zatloukal J, Kern C, Marti RA. Advantages of intrathecal nalbuphine, compared with intrathecal morphine, after cesarean delivery: an evaluation of postoperative analgesia and adverse effects. Anesth Analg. 2000;91:601-5.
Gomaaa HM, Mohameda NN, Zoheira HAH, Ali MS. A comparison between post-operative analgesia after intrathecal nalbuphine with bupivacaine and intrathecal fentanyl with bupivacaine after cesarean section. Egypt J Anaesth. 2014;30:405-10.
Bindra TK, Kumar P, Jindal G. Postoperative analgesia with intrathecal nalbuphine versus intrathecal fentanyl in cesarean section: a double-blind randomized comparative study. Anesth Essays Res. 2018;12:561-5.
Naaz S, Shukla U, Srivastava S, Ozair E, Asghar A. A comparative study of analgesic effect of intrathecal nalbuphine and fentanyl as adjuvant in lower limb orthopaedic surgery. J Clin Diagn Res. 2017;11:UC25-8.
Shalini A, Kokila N, Manjunatha HG, Supriya L. Comparative study of intrathecal nalbuphine versus clonidine as adjuvants to 0.5% isobaric levobupivacaine for elective infra-umbilical surgeries. Anaesth Pain Intensive Care. 2019;23:370-6.
Alhashemi JA, Crosby ET, Grodecki W, Duffy PJ, Hull KA, Gallant C. Treatment of intrathecal morphine-induced pruritus following caesarean section. Can J Anaesth. 1997;44:1060-5.
Raghuraman MS. Intrathecal nalbuphine-will it gain wider acceptance? A narrative review. Egypt J Anaesth. 2017;33:289-93.
Eskandr AM, Ebeid AM. Role of intrathecal nalbuphine on prevention of postspinal shivering after knee arthroscopy. Egypt J Anaesth. 2016;32:371-4.
Nada EN, Ezz GF. Comparison between intrathecal nalbuphine and intrathecal pethidine in preventing postspinal shivering after knee arthroscopy. Res Opin Anesth Intens Care. 2017;4:65-9.
Angral R, Bhat S, Sheikh TA, Saini H, Kalsotra SK. Comparison of intrathecal nalbuphine and magnesium sulphate for prevention of shivering in caesarean section: a randomised clinical study. J Clin Diag Res. 2023;17:UC15-9.
Fournier R, Van Gessel E, Macksay M, Gamulin Z. Onset and offset of intrathecal morphine versus nalbuphine for postoperative pain relief after total hip replacement. Acta Anaesthesiol Scand. 2000;44:940-5.
Malinovsky JM, Lepage JY, Karam G, Pinaud M. Nalbuphine reverses urinary effects of epidural morphine: a case report. J Clin Anesth. 2002;14:535-8.
Singh S, Sri Krishna V, Ambooken GC, Peter DK. Nalbuphine: an underrecognized battlefield analgesic and its utilization in combat care and peripheral areas. Med J Armed Forces India. 2024;80:41-5.
Coluzzi F, Bifulco F, Cuomo A, et al. The challenge of perioperative pain management in opioid-tolerant patients. Ther Clin Risk Manage. 2017;13:1163-73.
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