Continuous Epidural Analgesia after Major Abdominal Surgeries: A Comparative Study between Nalbuphine and Dexmedetomidine- A Randomized Double-Blind Clinical Trial

Mohamed Ramadan Ebrahim Metwally, Resident of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Abdelaziz AbdelMontelb Metawea, Professor of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Nevert A Abdelghaffar, Professor of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Tarek Habeeb Ramadan, Assistant Professor of Anesthesia, Surgical Intensive Care and Pain Management, Faculty of Medicine, Mansoura University, Mansoura, EgyptFollow

Corresponding Author

Tarek Habeeb Ramadan

Subject Area

Anaesthesia and Surgical Intensive Care

Article Type

Original Study

Abstract

Pain following major abdominal surgery remains a major clinical challenge despite advances in management. Considerable interest has focused on identifying the optimal continuous epidural adjuvants, nalbuphine or dexmedetomidine, that can achieve the best balance between analgesic efficacy and adverse-effect profile in this type of surgery. The objective of this trial was to compare the analgesic efficacy of epidural bupivacaine supplemented continuously with either nalbuphine or dexmedetomidine in adults undergoing elective major abdominal surgery.

Methods: This prospective double-blinded randomized clinical trial assigned 66 adult patients, classified as American Society of Anesthesiologists physical status I–III, who were scheduled to have major abdominal surgery under a combined regimen of general anesthesia (GA) and epidural analgesia. Patients were allocated in a random 1:1 ratio to one of two equal groups. Group D (n=33) received a continuous epidural infusion of bupivacaine (0.125%) combined with dexmedetomidine (4 μg/mL), whereas Group N (n=33) received bupivacaine (0.125%) combined with nalbuphine (0.2 mg/mL). The epidural infusion rate was adjusted between 4 and 12 mL/h according to the patient's analgesic requirements. The primary outcome was the measurement of postoperative pain intensity using the Visual Analog Scale (VAS) at rest and activity. Secondary outcomes included hemodynamic parameters, cumulative rescue analgesic consumption, time to request the first rescue analgesic, duration of sensory blockade, and complications.

Results: Group N exhibited a significantly longer time to request the rescue analgesia (15.06±4.72 vs. 10.36±2.59 hours, p=0.001) and longer sensory block duration (9.97±2.68 vs. 8±2.09 hours, p=0.001) compared to Group D. VAS score was significantly higher in Group D both at rest (at 24 hours; p=0.001) and during movement (at the 12-hour and 24-hour; p=0.001 and 0.004; respectively). Total use of analgesics was significantly lower in the N group (6.45±3.45 vs. 9.09±3.22 mg, p=0.002). The D group had a significantly increased incidence of bradycardia than in Group N (33.3% vs. 6.1%, p=0.005), with no significant intergroup differences in other complications.

Conclusion: Although both epidural nalbuphine and dexmedetomidine provided effective postoperative epidural analgesia following major abdominal surgery, nalbuphine was associated with prolonged analgesia, reduced postoperative pain scores, delayed rescue analgesic requirements, and a lower incidence of bradycardia.

Recommended Citation

Metwally, Mohamed Ramadan Ebrahim; Metawea, Abdelaziz AbdelMontelb; Abdelghaffar, Nevert A; and Ramadan, Tarek Habeeb (2026) "Continuous Epidural Analgesia after Major Abdominal Surgeries: A Comparative Study between Nalbuphine and Dexmedetomidine- A Randomized Double-Blind Clinical Trial," Mansoura Medical Journal: Vol. 56 : Iss. 3 , Article 5.
Available at: https://doi.org/10.58775/2735-3990.1614