Abstract
Neuraxial opioids provide excellent postoperative analgesia, but their use is associated with a frequent incidence of troublesome side effect such as pruritus, nausea and vomiting.

The aim of this study was to evaluate the efficacy of intrathecal nalpuphine alone or combined with magnesium sulphate on postoperative analgesia after major abdominal cancer surgery.

Ninety patients randomly assigned into three groups 30 patients each; group control received intrathecal 1ml saline 0.9% , group nalpuphine received intrathecal 0.8 mg nalpuphine and group nalpuphine+ received 0.8 mg nalpuphine + 100 mg magnesium sulphate 10% . Patients were monitored for vital signs ( heart rate, non invasive blood pressure , SaO2 and respiratory rate) , pain severity , sedation score , time to first request of rescue analgesic , total analgesic consumption and incidence of side effects were recorded in the first 24 hours postoperative.

The mean VAS scores immediately and at 2,4,6,12 and 18 hours postoperative were significantly reduced in nalpuphine and nalpuphine+ groups compared to control group (p=0.01). The time to first rescue analgesic requirement was significantly prolonged in nalpuphine and nalpuphine+ groups compared to control group (p=0.001).

The mean total consumption of tramadole IV rescue analgesia significantly reduced in nalpuphine and nalpuphine+ groups compared to control group (p=0.01).
There was no significant difference in the incidence of adverse effect in the three groups.

Intrathecal 0.8 mg nalpuphine alone or combined with intrathecal 100 mg magnesium sulphate improved the quality and the duration of post operative analgesia also provide an analgesic sparing effect without increasing the incidence of adverse effects.