Comparison of Intrathecal Bupivacaine + Nalbuphine with Bupivacaine alone for Intraoperative Analgesia in Patients undergoing Caesarean Section

Abstract

Objectives: To compare the efficacy of intrathecal bupivacaine combined with nalbuphine and bupivacaine alone for intraoperative analgesia in cesarean section procedures. Study design: Randomized controlled trial. Place and duration of study: Department of Anesthesia, Fauji Foundation Hospital Rawalpindi from March 2025 to May 2025. Methods: A total of 70 pregnant women aged >18 to < 45 years with a gestational age ≥ 37 weeks, scheduled for elective cesarean section under spinal anesthesia were enrolled in this study and randomized into two equal groups of 35 patients each. Women in Group BN received intrathecal bupivacaine with nalbuphine, while women in Group B only received intrathecal bupivacaine. The primary outcomes were set as block onset time and block duration (both sensory and motor) while secondary outcomes included time to rescue analgesia and the occurrence of adverse events. Results: The mean age of women in this study was 28.74 ± 5.4 years ranging from 19 to 42 years. The results of primary outcomes of the study showed that addition of nalbuphine significantly accelerated the block onset (both sensory and motor, with p< 0.0001 and p<0.001 respectively) and prolonged duration of block (Both sensory and motor, p<0.001 for both).  Time required for the first rescue analgesia was also significantly higher in Group BN compared to Group B (p<0.001). There was no significant difference between the two groups for different adverse events recorded during the study. Conclusion: Nalbuphine when combined with intrathecal bupivacaine offered significantly faster onset of both sensory and motor blockade, prolonged duration of anesthetic effect, and prolonged time to rescue analgesia in cesarean section procedures.