Comparison of IV Nalbuphine versus ibuprofen for Postoperative Pain control in cesarean section

To evaluate the effectiveness of intravenous (IV) nalbuphine versus IV ibuprofen for postoperative pain relief following cesarean section under general anaesthesia.

This randomized controlled trial was conducted at the department of obstetrics and gynecology, Nishtar Hospital, Multan, Pakistan from March 2024 to August 2024. A total of 80 females, aged between 18-45 years, gestational age above 32 weeks, body mass index (BMI) ≤ 30 kg/m², who were planned to undergo elective cesarean were included. Post-operatively, females in Ibuprofen group were given 800 mg Ibuprofen in 200 ml normal saline intravenously (IV) at the time of arrival in the ward. Women in Nalbuphine group received 20 mg nalbuphine in 200 ml normal saline IV at the time of arrival in the ward. Post-operative visual analog scale (VAS) scores, need for rescue analgesia, satisfaction, and side effects were noted.

Post-operatively, the Nalbuphine group showed better pain control than the Ibuprofen group at one hour (p<0.001), three hours (p<0.001), and six hours (p=0.011). Rescue analgesia was required more frequently in the Ibuprofen group (70.0% vs. 17.5%, p<0.001). Patient satisfaction was higher in the Nalbuphine group (62.5% vs. 12.5%, p<0.001). Nausea (20.0% vs. 10.0%, p=0.210), and gastrointestinal discomfort (2.5% vs. 12.5%, p=0.090) were statistically similar. Drowsiness was more frequent with Nalbuphine group (25.0% vs. 5.0%, p=0.012).

This study demonstrated that IV Nalbuphine was more effective than IV Ibuprofen for postoperative pain relief following cesarean section under general anesthesia. Nalbuphine provided superior pain control, reduced the need for rescue analgesia, and resulted in higher patient satisfaction.

Trial registration at clinicaltrials.gov as NCT06594224.