A meta‐analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper‐limb orthopaedic trauma surgery

The adjuvant effectiveness of nalbuphine in context of brachial plexus block (BPB) in patients undergoing upper‐limb orthopaedic trauma surgery has remained uncertain. The purpose of this meta‐analysis was to evaluate the analgesic benefit of mixing nalbuphine into local anaesthetics in BPB for wound pain from upper‐limb trauma surgery. Primary outcome was the duration of analgesia. Seventeen trials (1104 patients) were analysed. Patients receiving nalbuphine have an increased weighted mean difference (WMD) 95% confidence interval of the duration of analgesia by 186.91 minutes (133.67 to 240.16) (P < 0.001). Compared to placebo, nalbuphine shorten the onset time of sensory and motor block by WMD of 2.59 (1.27 to 3.92) and 3.06 minutes (1.65 to 4.48) (P < 0.001), respectively. Meanwhile, nalbuphine prolonged the durations of sensory and motor block (P < 0.001). Qualitative and quantitative synthesis revealed no differences with regard to the outcomes related to side‐effects. There is moderate‐quality evidence that the addition of nalbuphine to local anaesthetics for BPB in patients undergoing upper‐limb orthopaedic trauma surgery significantly prolongs the duration of analgesia, while preserving a similar safety‐profile compared with local anaesthetics alone. However, these benefits should be further weighed against nalbuphine‐related neurological safety in future studies.