A Dose-Response Study With Nalbuphine Hydrochloride for Pain in Patients After Upper Abdominal Surgery

Pugh, G.C.; Drummond, Gordon B.

doi:10.1093/bja/59.11.1356

Cited by 40 publications

(23 citation statements)

References 6 publications

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“…The incidence of other adverse effects is shown in Table 5. suggest that analgesia is inadequate in a large proportion of patients (19)(20)(21). Our results place nalbuphine analgesia between these extremes.…”

Section: Cardiovascular Changesmentioning

confidence: 59%

Influence of perioperative nalbuphine and fentanyl on postoperative respiration and analgesia

Rawal

Wennhager

1990

Acta Anaesthesiol Scand

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In a double-blind study the relative postoperative respiratory and analgesic effects of perioperatively administered nalbuphine and fentanyl were compared in 60 females undergoing gynecological surgery under i.v. anesthesia. One milliliter (10 mg) nalbuphine was considered equipotent to 1 ml (100 micrograms) fentanyl. In the recovery period pain was assessed by visual analog score (VAS) and recovery by Pegboard scoring. Respiratory function was evaluated by continuous monitoring of respiratory frequency and end-tidal CO2 (ETCO2) and by frequent arterial blood gas analyses. The total volume of analgesic required for surgical analgesia was similar in the two groups. Patients in the nalbuphine group showed mild to moderate increases in pulse rate during the intubation phase and in blood pressure during surgery. Fentanyl was more effective in suppressing these cardiovascular responses. Within the first 15 min following recovery, increasing PaCO2 and ETCO2 as well as respiratory rates below 10/min were noted in 8 patients, who all belonged to the fentanyl group; in 4 of these patients i.v. naloxone had to be administered to reverse respiratory depression. Prolonged sedation was a common feature in patients receiving nalbuphine. It was concluded that fentanyl was superior to nalbuphine in attenuating the pressor responses to intubation and surgery. However, fentanyl was associated with respiratory depression in a considerable number of patients. The quality and duration of postoperative analgesia were similar in the two groups.

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Section: Cardiovascular Changesmentioning

confidence: 59%

Influence of perioperative nalbuphine and fentanyl on postoperative respiration and analgesia

Rawal

Wennhager

1990

Acta Anaesthesiol Scand

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“…Therefore, patient-data may help to correlate plasma-levels with its anti-analgesic effects. Pugh et al used a similar infusion rate as in the present study in patients after abdominal surgery with adequate analgesic action and very comparable plasma-levels (37–145 μg/L) [25]. …”

Section: Discussionmentioning

confidence: 99%

Improving animal welfare using continuous nalbuphine infusion in a long-term rat model of sepsis

Jeger

Arrigo

Hildenbrand

et al. 2017

ICMx

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BackgroundSepsis research relies on animal models to investigate the mechanisms of the dysregulated host response to infection. Animal welfare concerns request the use of potent analgesics for the Refinement of existing sepsis models, according to the 3Rs principle. Nevertheless, adequate analgesia is often missing, partly because the effects of analgesics in this particular condition are unknown. We evaluated the use of nalbuphine, an opioid with kappa agonistic and mu antagonistic effects, in rats with and without experimental sepsis.MethodsMale Wistar rats were anesthetized with isoflurane and instrumented with a venous line for drug administration. Arterial cannulation allowed for blood pressure measurements and blood sampling in short-term experiments of non-septic animals. Nalbuphine (or placebo) was administered intravenously at a dose of 1 mg/kg/h. Long-term (48 h) experiments in awake septic animals included repetitive clinical scoring with the Rat Grimace Scale and continuous heart rate monitoring by telemetry. Sepsis was induced by intraperitoneal injection of faecal slurry. Nalbuphine plasma levels were measured by liquid chromatography—high resolution mass spectrometry.ResultsIn anesthetized healthy animals, nalbuphine led to a significant reduction of respiratory rate, heart rate, and mean arterial pressure during short-term experiments. In awake septic animals, a continuous nalbuphine infusion did not affect heart rate but significantly improved the values of the Rat Grimace Scale. Nalbuphine plasma concentrations remained stable between 4 and 24 h of continuous infusion in septic rats.ConclusionsIn anaesthetised rats, nalbuphine depresses respiratory rate, heart rate, and blood pressure. In awake animals, nalbuphine analgesia improves animal welfare during sepsis.

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“…Two studies [26,27] re ported that, after upper abdominal surgery, respiratory frequency, the only ventilatory variable measured, did not change after nalbuphine.…”

Section: Discussionmentioning

confidence: 99%

“…Although some rare cases of de layed respiratory depression have been reported [20][21][22], these methods have been shown to provide good pain re lief with a low level of associated side effects. Generally, postoperative analgesia did not modify the ventilatory pattern [23,24] and partially restored the preoperative pulmonary volumes [20,[24][25][26], Among these methods, parenteral systemic administration of opioids remains widely used because of its strong analgesic effect and its technical simplicity.…”

Section: Discussionmentioning

confidence: 99%

Nalbuphine Analgesia Preserves Ventilation after Thoracotomy despite a Reduction in Inspiratory Drive

Hannhart

Boulanger²,

Audibert³

et al. 1992

Respiration

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The respiratory effects of analgesia with nalbuphine were studied in 9 patients after thoracotomy. The pain score was measured by a visual analogue scale. Ventilatory pattern and occlusion pressure (P_0.1) were studied during spontaneous breathing and during CO₂ rebreathing, before and 0.5,1, 2.5, 3.5 and 6 h after a 0.3-mg · kg^-1 dose of intravenous nalbuphine. Compared to baseline values obtained before the injection, nalbuphine produced a decrease in the pain score (p < 0.001) during the 6-hour experiment period. In spontaneous breathing, P_0.1 was reduced by 15% in 1 h and remained decreased during 3.5 h (p < 0.05), whilst PaCO₂ and ventilation (V_E) remained unchanged. The P_0.1 responsiveness to CO₂ was decreased from 0.5 to 2.5 h after the nalbuphine injection (p < 0.05), but the V_E responsiveness to CO₂ was reduced only after 1 h (p < 0.01). This study shows that, while post-thoracotomy pain was reduced by analgesia, neuromuscular inspiratory drive and chemosensitivity to CO₂ were weakened, without any change in spontaneous ventilation. A partial improvement in the thoracopulmonary mechanics induced by the reduction in chest pain could explain the maintenance of ventilatory level in spite of a decreased neuromuscular inspiratory drive.

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A Dose-Response Study With Nalbuphine Hydrochloride for Pain in Patients After Upper Abdominal Surgery

Cited by 40 publications

References 6 publications

Influence of perioperative nalbuphine and fentanyl on postoperative respiration and analgesia

Influence of perioperative nalbuphine and fentanyl on postoperative respiration and analgesia

Improving animal welfare using continuous nalbuphine infusion in a long-term rat model of sepsis

Nalbuphine Analgesia Preserves Ventilation after Thoracotomy despite a Reduction in Inspiratory Drive

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