Comparison of Analgesic Efficacy of Nalbuphine with Tramadol as Adjuvant to Local Anaesthetic in Caudal Block in Children


  • Muhammad Imran Khan Department of Anesthesia, Combined Military Hospital, Quetta/National University of Medical Sciences (NUMS) Pakistan
  • Muhammad Rashid Department of Anesthesia, Medical Battalion, Tolti Pakistan
  • Usama Khalid Department of Anesthesia, Medical Battalion, Bagh Pakistan
  • Kaukab Majeed Kayani Department of Anesthesia, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Shahid Maqsood Department of Anesthesia, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan
  • Humayun Munir Tarar Department of Anesthesia, Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan



Caudal Block, Children, Nalbuphine, Pain, Post-operative pain, Tramadol


Objective: To compare the mean time of first rescue analgesia with Nalbuphine versus Tramadol as an adjuvant to
Bupivacaine given for caudal block in children.

Study Design: Quasi-experimental study

Place and Duration of Study: Anesthesiology Department, Bolan Medical Complex Hospital, Quetta Pakistan, from Feb to Aug 2019.

Methodology: The study included 60 patients, of either gender, aged 3-12 years. Group-A included patients who received 0.125% Bupivacaine 1ml/kg with Tramadol 2mg/kg body weight caudally. Group-B included patients who received 0.125% Bupivacaine with Nalbuphine 0.1mg/kg body weight caudally. The time required for the first rescue analgesia call was noted in all patients. Paracetamol 10 mg/kg intravenous was given as a rescue analgesic in all patients.

Results: The mean age of patients was 8.30±3.03 years, and mean weight of patients was 23.33±6.92 Kg. There were 26(43.33%) female and 34(56.67%) male patients. The mean pain score was 3.53±1.43 in the Tramadol-Group and 1.86±1.25 in the Nalbuphine-Group (p-value<0.001). The mean time of first rescue analgesia showed significant prolongation in the Nalbuphine-Group compared to the Tramadol-Group.

Conclusion: A single dose of Nalbuphine as an adjunct to Bupivacaine is superior to Tramadol in reducing post-operative pain when given caudally in paediatric patients. It also significantly prolongs the duration of analgesia in children.


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How to Cite

Muhammad Imran Khan, Muhammad Rashid, Usama Khalid, Kayani KM, Shahid Maqsood, Humayun Munir Tarar. Comparison of Analgesic Efficacy of Nalbuphine with Tramadol as Adjuvant to Local Anaesthetic in Caudal Block in Children. Pak Armed Forces Med J [Internet]. 2024 Apr. 29 [cited 2024 May 24];74(2):348-51. Available from:



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