Excessive morphine requirements after pre-hospital nalbuphine analgesia.

Houlihan, Kathleen; Mitchell, Robert J.; Flapan, A. D.; Steedman, D J

doi:10.1136/emj.16.1.29

Cited by 27 publications

(14 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This has been reported in a previous study, 14 although others have not observed this effect. 15 16 In conclusion, a rapid dosing regimen of nalbuphine is more effective than and equally as safe as a cautious regimen.…”

Section: Discussionsupporting

confidence: 79%

Less IS less: a randomised controlled trial comparing cautious and rapid nalbuphine dosing regimens

Woollard¹

2004

Emergency Medicine Journal

View full text Add to dashboard Cite

Objective: This study aimed to determine which of two paramedic administered nalbuphine dosing regimens combined the greater analgesic effect with the minimum of adverse events. Methods: Patients suffering from chest pain or trauma were randomised to receive either a rapid dosing regimen (10 mg over 30 seconds, repeated once after three minutes if pain score remained above three) or a cautious regimen (5 mg over two minutes, repeated at three minute intervals if pain score remained above three to a maximum dose of 20 mg). Data were collected on analgesic effectiveness, changes in vital signs, and patient reported side effects. Results: The pain score fell by a mean of 4.29 and 3.49 in the rapid and cautious regimen groups respectively (difference = 0.79, 95% CI 0.09 to 1.5, p = 0.028). However, over half the patients in both groups continued to suffer significant pain on arrival at hospital. There were no significant changes in vital signs after nalbuphine, but there was a greater incidence of patient reported drowsiness in rapid regimen patients (42% compared with 21%, 95% CI = 6.96 to 34.12%, p = 0.003). Conclusion: A rapid dosing regimen of nalbuphine using 10 mg increments is more effective than and equally as safe as a cautious regimen using 5 mg increments. Further research is required to determine if a maximum dose exceeding 20 mg would result in fewer patients continuing to suffer significant pain before arrival at hospital.

show abstract

Section: Discussionsupporting

confidence: 79%

Less IS less: a randomised controlled trial comparing cautious and rapid nalbuphine dosing regimens

Woollard¹

2004

Emergency Medicine Journal

View full text Add to dashboard Cite

show abstract

“…14 Some researchers have voiced concerns about the use of nalbuphine by paramedics, especially the potential for delay at the scene 15 and the possibility of antagonism of other opioids, should further analgesic therapy be required after arrival at hospital. 16 However, other authors have not observed these effects. 17 18 Nalbuphine's manufacturers recommend a dosing regimen of 10 mg to 20 mg for a 70 kg patient.…”

Section: Introductionmentioning

confidence: 95%

Hitting them where it hurts? Low dose nalbuphine therapy

Woollard

Jones²,

Pitt³

et al. 2002

Emergency Medicine Journal

View full text Add to dashboard Cite

Objective: To determine if low dose nalbuphine provides an adequate reduction in pain with minimal side effects. Methods: Prospective cohort of 115 patients given nalbuphine by paramedics in Wales and the English borders. Outcome measures: (1) Mean total dose of nalbuphine administered, change in pain score, time to adequate pain relief (score below four), and change in respiratory rate and systolic blood pressure; (2) proportion of patients continuing to suffer moderate to severe pain on arrival at hospital; (3) incidence of adverse events. Results: Full data were obtained for all patients. The mean total dose of nalbuphine administered was 6.09 mg (range 2.5 to 12.5 mg). This was significantly higher in trauma than ischaemic chest pain patients (7.03 versus 5.13 mg). The mean reduction in pain score was −3.97 (95% CI −4.38 to −3.57, p<0.001). The mean time to adequate pain relief (where this was achieved) was 15.7 minutes (95% CI 13.4 to 17.9 minutes). On arrival at hospital 60% of patients (n=69, 95% CI 50.9 to 68.5%) still met ambulance criteria for analgesia (70.7% of trauma patients and 49.1% with ischaemic chest pain). Systolic blood pressure fell by a mean of −3.67 (95% CI −6.76 to −0.58, p=0.02) and respiratory rate increased by a mean of 1.63 (95% CI 1.08 to 2.17, p<0.001). Two patients complained of nausea (1.74%, 95% CI 0.5 to 6.0%). No other adverse events were reported. Conclusion: Low dose nalbuphine results in few adverse events, but offers poor pain control for a high proportion of patients. RESEARCH OBJECTIVESResearch question Does a low dose nalbuphine dosing regimen provide an adequate reduction in pain score with minimal side effects? Research aimsTo determine: (1) the mean total dose of nalbuphine administered; (2) the mean change in pain score; (3) the mean time to adequate pain relief (pain score below four) from the start of the first dose; (4) the proportion of patients continuing to suffer moderate to severe pain on arrival at hospital; (5) the proportion of patients receiving further analgesia after hospital admission; (6) the mean post-nalbuphine change in: (a) respiratory rate; (b) blood pressure; (7) the incidence of adverse events such as nausea, vomiting or dizziness. BACKGROUND

show abstract

“…Authors have previously expressed concerns over the potential of nalbuphine to increase requirements of opiate analgesics after arrival at hospital due to its partial antagonist effect 5 6. The potential for nalbuphine to produce withdrawal in opiate dependent people has been explored in a study using opiate dependent volunteers, where it was found that the withdrawal syndrome precipitated by nalbuphine was indistinguishable from that produced by giving naloxone 7.…”

Section: Discussionmentioning

confidence: 99%