الفهرس 
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Abstract
Most of the patients undergoing surgery will suffer pain.[2] Among all the surgeries, abdominal ones are the most painful, and about 70% of those undergoing upper abdominal surgery experience postoperative severe pain.
Inadequate postoperative pain relief would result in many counterproductive physiologic and psychological consequences that would cause significant morbidity and mortality.
Hence, multimodal analgesia aims at effective pain control, the alleviation of host stress response to pain, and minimizing the side effects of large single opioid doses, resulting in early postoperative mobilization, and recovery. That’s why, Enhanced Recovery After Surgery (ERAS) programs hold multimodal analgesia as a core principle.
Transversus abdominis plane (TAP) block considers a modality of pain management following major abdominal cancer surgeries. It is relatively newer approach of injecting local anesthetics into the plane between the internal oblique and transversus abdominis muscle and thus giving pain relief. TAP block is suggested as part of the multimodal anesthetic approach to enhance recovery after lower abdominal surgeries.
Various adjuvants have been used to improve the quality and increase the duration of the local anesthetic action in different peripheral nerves and regional block techniques, such as α2 agonists (dexmedetomidine), midazolam, dexamethasone, or nulbuphine.
Nulbuphine is an opioid agonist-antagonist and is widely used as adjuvant to local anaesthetics to enhance the duration of analgesia, for various regional anaesthetic blocks due to its affinity to κ-opioid receptors.
In this study, we are trying to determine whether the addition of nulbuphine in two different doses as an adjunct to bupivacaine in transversus abdominis plane block confers better post-major abdominal cancer surgeries pain management or not.
Ninety patients scheduled for major abdominal cancer surgeries were randomly allocated to one of three groups. group (B) received TAP block with bupivacaine only, group (N10) received TAP block with bupivacaine and 10 mg nulbuphine, and group (N20) received TAP block with bupivacaine and 20 mg nulbuphine . Our primary outcome was the time of the first request of rescue analgesia. The secondary outcomes were total morphine consumption in the first postoperative 24 hours, postoperative VAS scores, Spirometric lung functions (FEV1, FVC, and FEV1/FVC), and postoperative side effects.
There is significant difference between the group (B), group (N10) and group (N20) in the 1st request of analgesia and total amount of morphine, VAS score and respiratory function. However, there is no significance between three groups in haemodynamics and side effects.
The use of nulbuphine to bupivacaine in single-injection subcostal TAP block controls pain and decreases opioid consumption after abdominal cancer surgery in a dose–dependent manner.also, show improvement in postoperative respiratory parameters and without serious side effect.