Postoperative Nalbuphine Dosing and Multimodal Analgesic Strategies

Postoperative Breakthrough Pain Management

Adult patients with postoperative breakthrough pain should receive nalbuphine 0.1–0.2 mg/kg IV, titrated to effect, with repeat dosing every 3–4 hours as needed. 1

Dexamethasone 8 mg IV at induction can be administered together with nalbuphine to reduce postoperative pain and the incidence of nausea and vomiting. 2
Intravenous lidocaine – an initial bolus of 1–2 mg/kg followed by a continuous infusion of 1–2 mg/kg/h – is recommended when nalbuphine is used for major surgery without regional analgesia, providing additional analgesic and anti‑hyperalgesic effects. 2
Ketamine 0.5 mg/kg IV may be added to nalbuphine for patients at high risk of severe postoperative pain or those on chronic opioid therapy, enhancing analgesia and reducing opioid requirements. 2