Combination of opioid agonist and agonist–antagonist: patient-controlled analgesia requirement and adverse events among different-ratio morphine and nalbuphine admixtures for postoperative pain

Yeh, Yu-Chang; Lin, Tzu-Fu; Lin, Feng Sheng; Wang, Y.-P.; Chen, Lin; Sun, Wei‐Zen

doi:10.1093/bja/aen213

Cited by 70 publications

(62 citation statements)

References 22 publications

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“…There was no difference in pain scores and side effects between fentanyl-morphine and fentanyl PCA (Friedman et al, 2008 Level II). Beneficial effects on pain relief and the incidence of pruritus in a comparison of morphine, nalbuphine and varying combinations of the two drugs were dependent on the ratio of drugs used (Yeh et al, 2008 Level II). The addition of alfentanil to morphine resulted in no differences in pain relief or adverse effects compared with morphine alone, although patients who received the alfentanil-morphine mixture rated speed of onset and effectiveness of analgesia as better (Ngan Kee et al, 1999 Level II).…”

Section: Chaptermentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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Section: Chaptermentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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“…Many studies have reported that incidence of adverse effects like pruritus and postoperative nausea and vomiting is lower with nalbuphine in comparison with morphine. [4][5][6][7][8][9] Reviews on preclinical pharmacology of this drug suggest that nalbuphine moiety is approximately 10 times more pharmacologically potent than the mixed opioid agonist-antagonist butorphanol on an "antagonist index" scale, which quantitates the drug's ability to act both as an analgesic (via opioid κ-receptor agonism) and as a µ-receptor antagonist. 10 The opioid antagonist activity of nalbuphine is one-fourth as potent as nalorphine and 10 times that of pentazocine.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Analgesic Effects of Intravenous Nalbuphine and Pentazocine in Patients posted for Short-duration Surgeries: A Prospective Randomized Double-blinded Study

Apte¹,

Bhalerao²,

Lokapur³

et al. 2017

Journal on Recent Advances in Pain

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Background and objectives: Postoperative pain influences the long-term outcome of the patient in a big way. We performed a randomized prospective double-blind study to evaluate the effects of intravenous (IV) nalbuphine and compared it with IV pentazocine. The primary objective was to compare the duration of analgesia of IV nalbuphine and IV pentazocine and the secondary objective was to study the side-effect profile.

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“…Analgesic effect is additive and decrease the incidence of pruritis and also antagonize the respiratory depressant activity of other narcotics. (1,2,3,4,5) Nalbuphine is a partial agonist and has its effects at the kappa receptors. This is important as it suggests a ceiling effect is be present in the response produced.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Nalbuphine With 0.5% Bupivacaine and Normal Saline With 0.5% Bupivacaine for Post - Operative Epidural Analgesia

P¹,

B²,

B³

et al. 2015

jemds

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AIM:Our aim is to evaluate the role of Nalbuphine as an additive to Bupivacaine to increase the duration of analgesia postoperatively by epidural anaesthesia. METHODS: 60 patients randomly allocated into two groups, 30 patients in each of both sexes ranging from 18-50 yrs age group of ASA grade I and II, posted for lower abdominal surgeries using 0.2mg/kg of Nalbuphine (Made to 1ml) with 0.5% Bupivacaine 19ml in study group epidurally with control group 0.5% Bupivacaine with 1ml of normal saline. RESULT: Epidural Nalbuphine produces early onset of sensory blockade significantly at 3.23±0.97mins (Control group 15.30±2.97mins), and prolongs the duration of postoperative analgesia significantly up to 449.67±39.43mins. (Control group 185.93± 32.43mins). CONCLUSION: In conclusion epidural Nalbuphine 0.2mg/kg with 0.5% Bupivacaine produces early onset of analgesia and prolonged duration of analgesia compared with 0.5% Bupivacaine with Normal saline.

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Combination of opioid agonist and agonist–antagonist: patient-controlled analgesia requirement and adverse events among different-ratio morphine and nalbuphine admixtures for postoperative pain

Cited by 70 publications

References 22 publications

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Comparison of Analgesic Effects of Intravenous Nalbuphine and Pentazocine in Patients posted for Short-duration Surgeries: A Prospective Randomized Double-blinded Study

Comparison of Nalbuphine With 0.5% Bupivacaine and Normal Saline With 0.5% Bupivacaine for Post - Operative Epidural Analgesia

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