Prophylactic Nalbuphine to Prevent Neuraxial Opioid-Induced Pruritus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Tubog, Tito D; Harenberg, Jennifer L; Buszta, Kristina; Hestand, Jennifer D.

doi:10.1016/j.jopan.2018.06.098

Cited by 20 publications

(25 citation statements)

References 37 publications

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“…33 Ibrahim et al found that the incidence and severity of postoperative nausea, vomiting, and pruritus were significantly reduced when adding nalbuphine to the mixture of bupivacaine and morphine in patient who underwent a cesarean section delivery, without affecting the analgesic effect. 34 This finding was comparable with the meta-analysis reported by Tito et al 35 Some studies also compared the effect of nalbuphine and fentanyl when adding to LAs in spinal anesthesia, and found that nalbuphine and fentanyl group both had better anesthetic effect, but the nalbuphine group had significantly lower side effects than the fentanyl group, and was more effective for the childbirth pain. 18,36 This result was consistent with our meta-analysis.…”

Section: Discussionsupporting

confidence: 85%

Nalbuphine for spinal anesthesia: A systematic review and meta‐analysis

Zhang

Wang

2021

Pain Practice

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Purpose Various adjuvants for prolongation of intra‐operative and postoperative analgesia have been clinically studied, but the safety and efficiency of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia remains unconfirmed. Therefore, we conducted a meta‐analysis about the effect of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia in regard to time of onset of sensory blockade and motor blockade, duration of motor blockade, 2‐segment sensory regression time, the duration of analgesia, and incidence of side effects to provide a reliable basis for clinical application. Methods Databases, including PubMed, Cochrane, EMBASE, Web of Science, CNKI, CBM, WanFang, and Viper, were searched for eligible studies. Data were extracted according to the proposed inclusion and exclusion criteria, RevMan version 5.3 and Stata 16 were selected to perform meta‐analysis. Results Eighteen published studies including 1633 patients met the inclusion criteria. The results showed that adding nalbuphine to local anesthetics for spinal anesthesia can prolong two‐segment sensory regression time (mean difference [MD] = 24.31; 95% confidence interval [CI] = 19.61–29.00, p < 0.001) and the duration of analgesia (MD = 118.11; 95% CI = 71.34–164.89, p < 0.001) without significantly increasing the incidence of adverse reactions in comparison to normal saline group. In addition, the analgesic effect of nalbuphine group was not statistically different from that of control group when compared with the potent opioid group, but the occurrence of hypotension (risk ratio [RR] = 0.35, 95% CI = 0.18–0.68, p < 0.01), the occurrence of shivering (RR = 0.19, 95% CI = 0.08–0.43, p < 0.01), and the occurrence of pruritus (RR = 0.23, 95% CI = 0.10–0.53, p < 0.01) was lower than the potent opioid group. Conclusions Nalbuphine as additives to local anesthetics can significantly prolong the two segments of sensory block and the average duration of analgesia without increasing the incidence of adverse reactions when compared with normal saline group. In addition, the analgesic efficacy of nalbuphine served as an adjunct to local anesthetics was clinically not different from that of the potent opioids, but the occurrence of hypotension, shivering, and pruritus was lower than the potent opioids.

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Section: Discussionsupporting

confidence: 85%

Nalbuphine for spinal anesthesia: A systematic review and meta‐analysis

Zhang

Wang

2021

Pain Practice

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“…It is also consistent with the fact that nalbuphine has lower incidence of adverse reactions and higher safety than morphine mentioned in previous studies [ 9 , 11 ]. This is because nalbuphine antagonist μ -opioid receptors can prevent or alleviate side effects such as skin pruritus, dizziness, nausea, and vomiting [ 26 ], while oxycodone with double μ -opioid receptors and κ -opioid receptors agonism may increase the occurrence of postoperative adverse reactions. Therefore, the nalbuphine group may be more advantageous in the prevention of adverse reactions than the other two groups.…”

Section: Discussionmentioning

confidence: 99%

[Retracted] Analgesic Effects of Different κ‐Receptor Agonists Used in Daytime Laparoscopic Cholecystectomy

Zhou

Wang

et al. 2021

BioMed Research International

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Background. Comparing the effect of two different κ-receptor agonists, nalbuphine and oxycodone, and regular morphine in patients for prophylactic analgesia of acute pain after daytime laparoscopic cholecystectomy. Methods. One hundred and twenty-four patients undergoing laparoscopic cholecystectomy were randomly allocated to receive nalbuphine (group N), oxycodone (group O), and morphine (group M). The three groups were all given intravenous injection (iv.) of 0.15 mg/kg injection before incision and 0.05 mg/kg injection at the end of pneumoperitoneum. The Visual Analogue Scale (VAS) scores (incision, visceral, and shoulder) and Ramsay sedation scores at 1, 2, 4, 8, 12, 16, 20, and 24 hours after surgery, the time of extubation, the incidence of postoperative adverse events, the satisfaction of pain treatment, and the duration of stay after surgery were all recorded. Results. Compared with group M, the VAS scores of visceral pain at rest decreased in group N and group O at 1-8 h after surgery ( P < 0.05 ). The VAS scores of visceral pain at movement in group N decreased longer than those in group O ( P < 0.05 ). Compared with that of group M, the postoperative time in Ramsay sedation score of group O increased longer than that of group N ( P < 0.05 ). Compared with group N, patients had worse sleep quality in group O, longer length of stay in group M, and lower satisfaction in both groups. Conclusion. Compared with morphine, prophylactic use of the κ-receptor agonists, nalbuphine and oxycodone, during laparoscopic cholecystectomy can reduce postoperative visceral pain. Furthermore, the nalbuphine group had fewer adverse reactions, better analgesia, and better satisfaction.

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“…However, significant complications such as hypotension, pruritus, respiratory depression, and nausea and vomiting have been reported with SA. These complications can be prevented and treated with evidence-based interventions such as co-loading of fluids, reduced LA dose, ondansetron, and nalbuphine (Heesen et al 2016, Ripollés et al 2015, Tubog et al 2019a, 2019b, 2017, 2018).…”

Section: Multimodal Analgesiamentioning

confidence: 99%

Overview of multimodal analgesia initiated in the perioperative setting

Tubog

2020

Journal of Perioperative Practice

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Despite progress in pain management in the perioperative setting, the literature is full of evidence that managing postoperative pain is suboptimal. Since the mechanism of pain is complex, the use of multimodal technique allows clinicians to use a combination of two or more drugs targeting different areas of pain transmission because of surgery. As part of enhanced recovery initiatives after surgery, healthcare and professional organisations incorporate the use of multimodal analgesia in surgical guidelines to improve patient satisfaction. This review aims to understand and summarise the current body of evidence involving the most common pharmacological therapies to manage postoperative pain in the preoperative setting.

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Prophylactic Nalbuphine to Prevent Neuraxial Opioid-Induced Pruritus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cited by 20 publications

References 37 publications

Nalbuphine for spinal anesthesia: A systematic review and meta‐analysis

Nalbuphine for spinal anesthesia: A systematic review and meta‐analysis

[Retracted] Analgesic Effects of Different κ‐Receptor Agonists Used in Daytime Laparoscopic Cholecystectomy

Overview of multimodal analgesia initiated in the perioperative setting

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