الفهرس 
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Abstract
One of the primary aims of anesthesia is to alleviate the patient’s pain and agony, by permitting the performance of surgical procedures without any discomfort. Relief of postoperative pain has gained real importance in recent years considering the central, peripheral and immunological stress response to tissue injury. Any expertise acquired in this field should be extended into the postoperative period, which is the period of severe, intolerable pain requiring attention. So there is a need for extended analgesia without any side effects to achieve this goal.
The use of opioids in intrathecal or epidural anesthesia has become popular to optimize postoperative analgesia. However, opioid-induced side effects, such as respiratory depression, nausea, vomiting, urinary retention and pruritus, limit their use.
Several investigations have shown that intrathecal or epidural administration of opioids produces a dose dependent modulation of spinal nociceptive processing in animals and humans and is not associated with sedation.
The purpose of this study was to assess the spinally mediated postoperative analgesic effects of intrathecal Nalbuphine as an adjunct to bupivacaine after lower abdominal surgeries in comparison to intrathecal bupivacaine plus fentanyl
60 patients came to Ain-shams Hospital for lower abdominal surgeies, They were randomly allocated into two equal groups (30 patients each) group F and group N
group F : Bupivacaine-Fentanyl
Patients received an intrathecal injection of 3 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (25 µg) fentanyl.
group N : Bupivacaine-Nalbuphine
Patients received an intrathecal injection of 3 ml of 0.5% heavy (hyperbaric) bupivacaine plus 0.5 ml (0.5 mg) Nalbuphine .
All patients were assessed and monitored for: Hemodynamics: ECG for heart rate, and non-invasive arterial pressure, respiratory rate and arterial oxygen saturation, onset of sensory block, onset of motor block, duration of analgesia & 1st rescue analgesia , duration of motor block, , adverse effects as: hypotension, bradycardia, respiratory depression, urinary retention, pruritus, shivering, nausea and vomiting were recorded.
Results & Conclusion of this study show that :
The addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia moderately prolonged the time of postoperative analgesia ,
The duration of postoperative analgesia is nearly the same in nalbuphine group & the fentanyl group.
There is more rapid onset of motor block in fentanyl group than in nalbuphine group but with no difference in sensory or motor block regression.
Hemodynamic stability & side effects incidence are the same in both groups.
No respiratory depression or degree of sedation occurs in both groups.