Abstract

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Background

Nalbuphine, a synthetic k-agonist and µ-antagonist, provides efficient pain relief while reducing opioid-related adverse effects. This study aims to compare the efficacy of intrathecal nalbuphine (ITN) with intrathecal morphine (ITM) for post-TKA pain.

Methods

A retrospective cohort analysis of 131 patients who underwent TKA with spinal anesthesia (SA), a single shot of adductor canal block, and periarticular injections was conducted. The patients were divided into 2 groups, Group N received 0.8 mg nalbuphine, and Group M received 0.2 mg morphine as an adjuvant to SA. Propensity-score matching was employed to compare the visual analog scales (VAS) of postoperative pain intensity, cumulative morphine use (CMU), maximum knee flexion angle, straight leg raise (SLR) ability, incidence of postoperative nausea and vomiting (PONV), and length of hospital stay (LHS).

Results

The mean VAS of group M were significantly lower than group N at 6, 12, 18, and 24 h (P < 0.01). Group M had lower CMU than group N at 24 h (P < 0.01) and 48 h (P < 0.01), while there was no significant difference between groups in terms of knee flexion angle and SLR at any time point. Additionally, 29.3 and 57.9% of patients in group N and M experienced PONV, respectively (p = 0.04), and group N had significantly shorter LHS compared to group M (P < 0.001).

Conclusion

Although, intrathecal morphine (ITM) still provides better pain control particularly in the first 24 h, patients who received intrathecal nalbuphine (ITN) had significantly fewer incidence of PONV, and shorter LHS.

References

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Acknowledgements

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The authors had no conflicts of interest. We thank Kantapon Warangkanagool, M.S.(Statistics), who provided expertise in statistical analysis. We also thank Siriluk Toolyodpun, MD, Kamonnop Sahasoonthorn, MD, Pawin Sudbanthad, MD, Sasawat Ratanapises, MD, for their technical assistance.

Funding

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

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Authors and Affiliations

1. Department of Anesthesiology, Faculty of Medicine, Naresuan University, 99 Moo 9, Phitsanulok, Thailand

   Chawisachon nonsri, Rawee Jongkongkawutthi, Inthiporn Kositanurit & Apirak Tewaritruangsri

2. Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand

   Piti Rattanaprichavej & Artit Laoruengthana

Contributions

CN, IK, PT and AL contributed to the conception and design of the study. CN, RJ, IK, PR and AL wrote and completed the manuscript. AL and PR responsible as surgeons who performed the operation. CN, RJ, IK and AT responsible as anesthesiologist who performed the spinal anesthesia. CN, RJ, IK, AT, PR and AL collected the required data. CN, RJ, IK, PR and AL responsible for data interpretation and performed the statistical analysis. RJ, IK and AL critical revise of the manuscript for important intellectual content. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Rawee Jongkongkawutthi.

Ethics declarations

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