Efficacy and safety of preemptive intrathecal morphine vs nalbuphine in lumbar spine
Abstract
Background & objective: Nalbuphine (agonist-antagonist) is very commonly used in the clinical practice, because ofits property to alleviates pain without the side effects associated with other narcotics. This research assessed theanalgesic efficacy of intrathecal morphine compared to nalbuphine in spine surgery.
Methodology: Eighty participants were randomly separated into two groups; Group M received 0.2 mg morphine, while Group N patients were administered 0.8 mg nalbuphine. Both drugs were mixed with saline to make a volume of 3 mL for intrathecal injection. The primary outcome was the duration of effective analgesia. Secondary outcomes included visual analog scale (VAS) scores, fentanyl consumption, and any observed adverse effects.
Results: Group M experienced a significantly prolonged duration of effective analgesia (P < 0.001) with significantly less postoperative fentanyl consumption compared to Group N (P < 0.001). The VAS scores were significantly lower in Group M than Group N at 1, 2, 4, and 6 hours after the procedure (all P < 0.001). Conversely, VAS scores were significantly higher in Group M than in Group N at 18 and 24 hours postoperative (P = 0.002 and 0.022, respectively). A significant increase in the incidence of postoperative nausea and vomiting (P = 0.011) and pruritus (P < 0.001) was observed in Group M compared to Group N.
Conclusion: Intrathecal nalbuphine provided analgesia in the early postoperative period and is more effective than morphine in reducing the risk of side effects.
Abbreviations: ERAS: enhanced recovery after surgery, ITM: intrathecal morphine, ITN: intrathecal nalbuphine,
Keywords: Lumber spine surgery; Morphine; Nalbuphine; Postoperative pain; intrathecal
Citation: Elghamry MR, Fathy SM, Hamoda NE, Elfert MAE. Efficacy and safety of preemptive intrathecal morphine vs nalbuphine in lumbar spine. Anaesth. pain intensive care 2025;30(1):7-15. DOI: 10.35975/apic.v30i1.3096
Received: July 03, 2025; Revised: October 03, 2025; Accepted: October 03, 2025
