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Randomized Controlled Trial
. 2025 Aug 8;35(1):341.
doi: 10.1007/s00590-025-04459-2.

Intrathecal nalbuphine at two doses reduces opioid use and pain after total knee arthroplasty: a randomized controlled trial

Chawisachon Nonsri  1 , Inthiporn Kositanurit  2 , Apirak Tewaritruangsri  3 , Kornthip Jeephet  1 , Piti Rattanaprichavej  1 , Artit Laoruengthana  1
Affiliations
Randomized Controlled Trial

Intrathecal nalbuphine at two doses reduces opioid use and pain after total knee arthroplasty: a randomized controlled trial

Chawisachon Nonsri et al. Eur J Orthop Surg Traumatol. .

Abstract

Purpose: This study aimed to assess the efficacy of different-dose intrathecal nalbuphine (ITN) in addition to adductor canal block (ACB) and its associated side effects.

Methods: This prospective randomized double-blinded controlled trial recruited 42 patients undergoing TKA at Naresuan University Hospital who received spinal anesthesia and ACB into three groups, each with 14 patients: Group A (control), Group B (additional ITN 0.8 mg), and Group C (additional ITN 1.2 mg). The primary outcome was the numeric rating scale (NRS) at rest and during movement at various time points. The secondary outcomes included the cumulative morphine use (CMU) and side effects.

Results: Forty-two patients (group A = 14; group B = 14; group C = 14) were randomized. All patients were analyzed. The group C had significantly lower NRS at rest at 6, 12, 24, and 48 h postoperatively, and significantly lower NRS during movement at 6 and 36 h postoperatively when compared to group A. There was no significant difference in NRS between group C and B, or between group B and A. The group B and C required significantly less CMU than the group A during the first 24, 48, and 72 h after TKA. The side effects, which included nausea, vomiting, drowsiness, respiratory depression, and shivering, were not significantly different among the groups.

Conclusion: Additional ITN, both 0.8 and 1.2 mg doses, effectively reduces CMU during the first 72 h after TKA. Given higher-dose ITN up to 1.2 mg provides benefit by further reducing pain scores, without increased side effects.

Trial registration clinical trials: TCTR20241012005, October 12, 2024.

Keywords: Intrathecal nalbuphine; Pain management; Postoperative nausea and vomiting; Total knee arthroplasty.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. AI-assisted technologies was used only in the writing process to improve the readability and language of the manuscript, and it was reviewed by a native English speaker.

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