الفهرس 
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Abstract
This study was to evaluate the effect of Nalbuphine given epidurally versus its effect when given systemically in patients receiving epidural morphine and undergoing major abdominal operations. Patients had been randomly classified according to the type of epidural mixture into 3 groups: Group A: (n = 15) Receive epidural mixture of bupivacaine 0.5% (1mg / kg) and preservative free morphine (150 µg /ml bupivacaine).Group B: (n = 15) Receive epidural mixture of bupivacaine 0.5% (1mg/kg), preservative free morphine (150 µg /ml bupivacaine) and preservative and buffer free Nalbuphine (300µg /ml bupivacaine). Group C: (n = 15) Receive epidural mixture of bupivacaine 0.5% (1mg/kg) and preservative free morphine (150 µg /ml bupivacaine) and systemic Nalbuphine (0.1mg /kg).There were Assessment of spost operative intensity of pain using Prince Henry pain scale, mean arterial blood pressure, heart rate, respiratory rate, sedation score and any complication( nausea, vomiting, itching).This study demonstrated that the addition of nalbuphine via intravenous or epidural routes could prevent the μ opioid mediated side effects. Nalbuphine seems to be a more suitable adjunct, it alleviates the epidural morphine induced pruritus, nausea and vomiting without reversing its analgesic effect.