COMPARISON OF ANALGESIC EFFECT AND SAFETY OF NALBUPHINE VS MORPHINE IN PATIENTS UNDERGOING MODIFIED RADICAL MASTECTOMY- A RANDOMIZED CONTROLLED SINGLE BLINDED TRAIL

Abstract

Comparison of analgesic effect and safety of nalbuphine vs morphine in patients undergoing Modified radical mastectomy- A Randomized Controlled single Blinded Trail

Background: Modified Radical Mastectomy (MRM) is a common surgical procedure for breast cancer and is often associated with significant postoperative pain. Morphine remains the gold standard for postoperative analgesia but is associated with various opioid-related side effects. Nalbuphine, a synthetic opioid with mixed agonist-antagonist activity, may offer effective analgesia with a better safety profile. This study was conducted to compare the analgesic efficacy and safety of nalbuphine versus morphine in female patients undergoing MRM under general anesthesia. Methods: This prospective, randomized, single-blinded clinical trial was conducted on 60 ASA I–II female patients aged 18–60 years undergoing elective MRM. Patients were randomized into two groups: Group M received morphine, and Group N received nalbuphine. Standardized anesthetic techniques were used. Postoperative pain was assessed using the Visual Analog Scale (VAS) at 30 minutes, 1, 2, 6, 12, and 24 hours. Secondary outcomes included intraoperative rescue analgesia (fentanyl), sedation scores, and adverse effects such as nausea, vomiting, pruritus, respiratory depression, and urinary retention.Results: Baseline demographics were comparable between groups. Group N (nalbuphine) had significantly lower VAS scores up to 6 hours postoperatively (p < 0.001) and required fewer intraoperative fentanyl boluses compared to Group M (morphine). The incidence of postoperative nausea and vomiting (30% vs 10%; p = 0.041) and pruritus (16.7% vs 0%; p = 0.019) was significantly higher in the morphine group. No cases of respiratory depression were observed in either group.Conclusion: Nalbuphine provided superior early postoperative analgesia and was associated with fewer opioid-related side effects compared to morphine. It may serve as a safer and effective alternative for pain management in patients undergoing MRM.