Abstract：
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).
CONCLUSIONS: 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.
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).
CONCLUSIONS: 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.
摘要：
背景：纳布啡，合成的k-激动剂和µ-拮抗剂，提供有效的疼痛缓解，同时减少阿片类药物相关的不良反应。本研究旨在比较鞘内注射纳布啡（ITN）与鞘内注射吗啡（ITM）治疗TKA后疼痛的疗效。
方法：对131例脊髓麻醉（SA）接受TKA的患者进行回顾性队列分析，一次内收肌运河阻塞，并进行关节周围注射。将患者分为2组,N组接受0.8毫克纳布啡，M组接受0.2mg吗啡作为SA的佐剂。倾向评分匹配用于比较术后疼痛强度的视觉模拟量表（VAS），累积吗啡使用(CMU)，最大膝关节屈曲角度,直腿提升（SLR）能力，术后恶心和呕吐（PONV）的发生率，住院时间（LHS）。
结果：在6、12、18和24h，M组的平均VAS明显低于N组（P<0.01）。24h（P<0.01）和48h时，M组的CMU低于N组（P<0.01）。而在任何时间点，两组间的膝关节屈曲角度和SLR均无显著差异。此外,N组和M组中29.3％和57.9％的患者经历了PONV，分别(p=0.04)，N组LHS明显短于M组(P<0.001)。
结论：虽然，鞘内注射吗啡（ITM）仍然提供更好的疼痛控制，特别是在最初的24小时，鞘内注射纳布啡（ITN）的患者PONV的发生率明显较低，更短的LHS。
方法：对131例脊髓麻醉（SA）接受TKA的患者进行回顾性队列分析，一次内收肌运河阻塞，并进行关节周围注射。将患者分为2组,N组接受0.8毫克纳布啡，M组接受0.2mg吗啡作为SA的佐剂。倾向评分匹配用于比较术后疼痛强度的视觉模拟量表（VAS），累积吗啡使用(CMU)，最大膝关节屈曲角度,直腿提升（SLR）能力，术后恶心和呕吐（PONV）的发生率，住院时间（LHS）。
结果：在6、12、18和24h，M组的平均VAS明显低于N组（P<0.01）。24h（P<0.01）和48h时，M组的CMU低于N组（P<0.01）。而在任何时间点，两组间的膝关节屈曲角度和SLR均无显著差异。此外,N组和M组中29.3％和57.9％的患者经历了PONV，分别(p=0.04)，N组LHS明显短于M组(P<0.001)。
结论：虽然，鞘内注射吗啡（ITM）仍然提供更好的疼痛控制，特别是在最初的24小时，鞘内注射纳布啡（ITN）的患者PONV的发生率明显较低，更短的LHS。
