Intraoperative pain, nausea, vomiting, hypotension, bradycardia are known side effects during lower abdominal surgery under spinal anesthesia, Time to 2 segment regression of sensory block and duration of effective analgesia prolonged with intrathecal (IT) 0.4 mg nalbuphine & IT 0.8 mg nalbuphine, but the incidence of side-effects was significantly higher with IT 0.8 mg nalbuphine compared with (IT) 0.4 mg nalbuphine.

So, the hypothesis of using IT nalbuphine mid away dose 0.6 mg between the best intraoperative analgesic effective dose 0.8 mg and the least side effect producing dose 0.4mg with the addition of epidural dexamethasone could augment the postoperative analgesia and reduce the unwanted side effects. Epidural dexamethasone in a full dose of 8 mg is probably more effective than lower doses to control moderate to severe post-operative pain. Dexamethasone 8mg dose is surgically safe neither produced delayed wound healing nor elevated blood glucose level.

Inclusion Criteria:

• American Society of Anesthesiologists physical class I or II.
• Undergoing laparotomy
• Undergoing oophorectomy
• Undergoing hysterectomy
• Undergoing rectal mass excision

Exclusion Criteria:

• Patient refusal.
• Hypersensitivity to amide local anesthetics.
• General contraindications to spinal anesthesia.
• Cardiac diseases.
• Hepatic failure.
• Renal failure.
• Respiratory failure.
• Communication barriers.

Double blind