Impact of Nalbuphine Timing on Pain Relief and Blood Stability in Older Adults Having Knee Replacement Surgery

What this Trial Is About

This research aims to evaluate the effects of administering nalbuphine, an opioid analgesic, at different perioperative time points on pain relief and hemodynamic stability in elderly patients undergoing total knee arthroplasty TKA. TKA is a common surgery to treat advanced osteoarthritis or rheumatoid arthritis, but patients often experience moderate to severe postoperative pain. Maintaining stable blood pressure and adequate brain perfusion during surgery is important to prevent heart and brain injury caused by tourniquet use and controlled hypotension. Participants will receive general anesthesia with a standardized regimen, including dexamethasone, midazolam, sufentanil, etomidate, and atracurium. They will be randomly assigned to one of three groups one receiving intravenous nalbuphine during anesthesia induction, another receiving nalbuphine after cement implantation, and a control group receiving no nalbuphine. Anesthesia will be maintained with continuous infusions of propofol and remifentanil in all groups. During the study, participants will be assessed for pain using the Visual Analog Scale VAS at various times after surgery, including 30 minutes postoperatively, which is the primary outcome. Hemodynamic parameters such as blood pressure and heart rate will be monitored at multiple perioperative time points. The use of rescue pain medication, adverse reactions, surgery duration, and airway device removal time will also be recorded. The study will continue until October 2026, involving elderly participants aged 65 to 90 years.

Nalbuphine Timing Effects on Hemodynamics and Analgesia in Elderly Patients