Efficacy of opioids and non-opioid analgesics in the treatment of post procedure pain of burned patients: a narrative review

Abstract Introduction Burns are a common trauma that cause acute severe pain in up to 80% of patients. The objective of this narrative review is to evaluate the efficacy of opioids, non-steroidal anti-inflammatory drugs, paracetamol, gabapentinoids, ketamine, and lidocaine in the treatment of acute pain in burn victims. Methodology The databases explored were PubMed, Embase, ClinicalTrials, and OpenGrey. The included randomized, controlled clinical trials assessed the analgesic efficacy of these drugs on hospitalized patients, had no age limit, patients were in the acute phase of the burn injury and were compared to placebo or other analgesic drugs. Studies describing deep sedation, chronic opioid use, chronic pain, and patients taken to reconstructive surgeries were excluded. The Jadad scale was used to evaluate quality. Results Six randomized controlled clinical trials (397 patients) that evaluated the analgesic efficacy of fentanyl (n = 2), nalbuphine (n = 1), ketamine (n = 1), gabapentin (n = 1), and lidocaine (n = 1) to treat post-procedural pain were included. Fentanyl, nalbuphine, and ketamine were effective, while lidocaine was associated with a slight increase in reported pain and gabapentin showed no significant differences. Two studies were of high quality, one was of medium high quality, and three were of low quality. No studies on the efficacy of NSAIDs or paracetamol were found. Conclusion Evidence of efficacy is very limited. Fentanyl, nalbuphine, and ketamine seem to be effective for controlling acute pain in burn patients, whereas gabapentin and lidocaine did not show any efficacy.

A meta-analysis on the effectiveness of postoperative analgesia with intrathecal nalbuphine versus intrathecal fentanyl as neuraxial adjuvants in cesarean section

@#<p><strong>Background: </strong>Inadequately treated postoperative pain can contribute significantly to morbidity in women undergoing cesarean section.  Recent studies showed that nalbuphine and fentanyl has promising result as neuraxial adjuvants in terms of postoperative analgesia and with lower incidents of adverse effect when use in cesarean section. </p><p><strong>Objective: </strong>To determine the effectiveness of postoperative analgesia with intrathecal nalbuphine versus intrathecal fentanyl as neuraxial adjuvants in cesarean section. </p><p><strong>Methods</strong>:  A meta-analysis following the PRISMA guidelines was performed.  Articles were searched through the Cochrane Library, PubMed.Gov and Pubmed Central, Google Scholar, HERDIN, WPRIM and ProQuest Guideline Central using different search strategies such as keywords and MeSH term.  Cochrane version 2 risk-of-bias tool for randomized trials (RoB 2) was used to assess for quality.  Quantitative data were pooled and analyzed using Review Manager 5.4. </p><p><strong>Results: </strong>A total of four trials, involving 425 full term pregnant women were analyzed. The pooled mean difference showed significantly longer duration of postoperative analgesia (MD=21.12 minutes, 95%CI=11.13,31.11, I2=73%), pooled risk ratio showed lesser risk for pruritus (RR=0.09, 95%CI=0.02,0.50, I2 = 0%) and postoperative nausea and vomiting (RR=0.38, 95%CI= 0.19,0.78, I2 = 11%) who received intrathecal nalbuphine compared to intrathecal fentanyl. </p><p><strong>Conclusions</strong>: The results of this meta-analysis demonstrates that the use of intrathecal nalbuphine appears to have a better outcome in increasing the duration of postoperative analgesia and with lesser incidence of PONV and pruritus than fentanyl.  However, due to the presence of heterogeneity it warrants that the results should be treated with caution especially with the possibility of publication bias. </p><p><strong>Recommendations: </strong>Better literature search through inclusion of high-quality studies from relevant databases and strict adherence on the uniformity of the dosage and <strong>methods</strong> used are very crucial to achieve the target clinical outcomes and minimize the publication bias. </p>

Sedative, analgesic, behavioral and clinical effects of intravenous nalbuphine-xylazine combination in camels (Camelus dromedarius)

This study examined the sedative, analgesic, behavioral, and clinical effects of a combination of xylazine (XY) and nalbuphine-xylazine (NA-XY) in camels. A total of five adult camels were used in a prospective randomized cross-over design with a wash out period of two weeks. Camels were allocated randomly to two treatment groups: the XY group (xylazine, 1.1mL/100 kg IV) and the NA-XY group (xylazine, 1.1mL/100 kg IV and nalbuphine, 1 mg/kg IV). The sedative, analgesic, behavioral, and clinical effects of XY and NA-XY combination were evaluated prior to administration (baseline) and at 5, 15, 30, 45, 60, 75, 90, and 120 minutes post-administration. The results showed that the NA-XY combination accelerates the onset of sedation and analgesia and prolongs the durations of both sedation (p < 0.001) and analgesia (p < 0.01). The behavioral parameters showed higher scores with a NA-XY combination than xylazine alone. Although a XY injection resulted in a significant decline in the heart and respiratory rate, the NA-XY combination group revealed a non-significant change in both clinical parameters compared to the baseline. In conclusion, the use of a NA-XY combination in camels improved the sedative and analgesic onset and duration with an improved outcome in the behavioral scores, as well as in both the heart and respiratory rates compared to XY alone.

Comparison of intrathecal fentanyl and nalbuphine: a prospective randomized controlled study in patients undergoing total abdominal hysterectomy

Objectives: 0.5% bupivacaine used in subarachnoid block provides only about 3 hours of analgesia. Opioids especially morphine and fentanyl are used as adjuvants to produce extended postoperative analgesia. Nalbuphine is an agonist antagonist and does not require a narcotic license, which is a must for procuring other opioids, so is easily available even in peripheral hospitals. This study was carried out to evaluate the efficacy of nalbuphine versus fentanyl as intrathecal adjuvant

Methodology: One hundred ASA 1-3 patients, aged 30-65 years posted for elective total abdominal hysterectomy [TAH] were included in this study and were randomly divided into two groups of fifty each. Group FB received 15 mg of 0.5% bupivacaine [3 ml] plus 25 micro g of fentanyl [0.5 ml] and Group NB received 15 mg 0.5% bupivacaine [3 ml] plus 1 mg nalbuphine [0.5 ml]. No sedative or analgesic was given preoperatively. The parameters noted were; the time for sensory block to reach T10 dermatome, time for the sensory level to fall from T6 to T8 dermatome, time for the first request of rescue analgesia, duration of motor block and any untoward side effect or complications. The statistical analysis was performed by STATA 11.2 [College Station TX USA]. Students t-test were performed for to find the significance difference between the study parameters

Results: The onset of sensory blockade, time to attain peak sensory block and complete motor block was significantly faster in Group FB [p < 0.001]. The duration of motor block was comparable in both the groups. The time for sensory block to regress by two segments was significantly longer in Group NB, 97.72 +/- 9.50 min, than in Group FB, 88.88 +/- 9.48 min. The time to first analgesic requirement in Group NB was 460.78 +/- 77.98 min compared to 283.44 +/- 78.97 min in Group FB [p < 0.001]. No statistical difference was seen in terms of adverse effects. Two patients in both groups complained of nausea. Hypotension and pruritus were seen in two and one patient respectively in Group FB

Conclusion: Although the time to onset and peak sensory level is longer with nalbuphine as intrathecal adjuvant than fentanyl, time for sensory level to regress by two segments and the postoperative analgesia time is longer with nalbuphine. So, nalbuphine is a good adjuvant in spinal anesthesia and has an advantage in centers without narcotics license

Comparison of single-dose nalbuphine versus tramadol for postoperative pain management in children: a randomized, controlled trial / 대한마취과학회지

BACKGROUND: Acute postoperative pain control in children is an essential component of postoperative care, particularly in daycare procedures. Giving patients continuous narcotic analgesics can be risky; however, a single dose may be sufficient. METHODS: This study used a prospective, randomized controlled design and was conducted at the Pediatric Surgery Unit, Services Hospital, Lahore. In total, 150 patients who underwent inguinal herniotomy (age range: 1–12 years) were randomly assigned to two groups: group A (nalbuphine) and group B (tramadol). Patients were given a single dose of either nalbuphine (0.2 mg/kg) or tramadol (2 mg/kg) immediately after surgery and pain was measured at 0, 1, 2, 4, and 8 h. RESULTS: The demographic characteristics were similar between the two groups. The mean pain score was lower in group A than in group B at 0 and 1 h (P < 0.05). However, at 4 h and 8 h, the pain scores in group A were still lower, but not significantly. In all, 9 patients (12.0%) required rescue analgesics in group A compared to 16 patients (21.3%) in group B (P = 0.051). The mean time for requirement of rescue analgesics was 6.5 ± 0.5 h in group A and 5.3 ± 1.7 h in group B (P = 0.06). CONCLUSIONS: A single dose of nalbuphine is sufficient, and superior to tramadol, for postoperative pain management in children who have undergone daycare procedures.

Expressions of matrix metalloproteinases-1 and -9 and opioid growth factor in rabbit cornea after lamellar keratectomy and treatment with 1% nalbuphine / Metaloproteinases de matriz 1, 9, e fator de crescimento opióide, em córneas de coelhos depois de ceratotomia e tratamento com nalbufina a 1%

ABSTRACT Purposes: To evaluate the effects of nalbuphine 1% on the expression of metalloproteinase 1 (MMP-1), metalloproteinase 9 (MMP-9), and opioid growth factor (OGF) in rabbit corneas after lamellar keratectomy. Methods: The rabbits were assigned to two groups: group nalbuphine (GN, n=30), which received 30 µL of nalbuphine 1% in 4 daily applications at regular intervals until corneal epithelialization, and group control (GC, n=30), which received physiological saline solution under the same conditions adopted in GN. The corneas were collected for immunohistochemistry on days 1, 3, 5, 7, and 9 after lamellar keratectomy, and the expressions of MMP-1, MMP-9, and OGF were analyzed. Results: The expressions of MMP-1 and MMP-9 increased until day 5 of the evaluation, with no differences observed between GN and GC (p>0.05). On days 7 and 9, significant reductions were observed in the expression of MMP-1 (p<0.01), with no differences observed between GN and GC (p>0.05). The expression of OGF was constant in all periods (p>0.05), restricted to the corneal epithelium, and there was no difference between the groups (p>0.05). Conclusions: The study results showed that nalbuphine 1% did not alter the expression patterns of MMP-1, MMP-9, and OGF in rabbit corneas after lamellar keratectomy. .

RESUMO Objetivos: Avaliar os efeitos da nalbufina 1% sobre a expressão da metaloproteinase 1 (MMP-1), da metaloproteinase 9 (MMP-9) e do fator de crescimento opióide (OGF), em córneas de coelhos submetidas à ceratectomia lamelar. Métodos: Constituíram-se dois grupos: grupo nalbufina (GN, n=30), que recebeu 30 µL de nalbufina 1% em 4 aplicações diárias, a intervalos regulares, até a epitelização corneal; controle (GC, n=30), que recebeu solução salina nas mesmas condições adotadas no GN. As córneas foram colhidas para imuno-histoquímica decorridos 1, 3, 5, 7 e 9 dias das ceratectomias lamelares, visando a se avaliarem as MMP-1, MMP-9 e OGF. Resultados: A expressão das MMP-1 e de MMP-9 se elevou até o quinto dia de avaliação, sem diferença entre GN e GC (p>0,05). Nos dias 7 e 9, observou-se redução significativa na expressão das enzimas (p<0,01), sendo que diferenças não foram observadas entre os grupos (p>0,05). O OGF exibiu imunomarcação constante em todos os períodos (p>0,05), restrita ao epitélio corneal. Não foram encontradas diferenças entre os grupos (p>0,05). Conclusões: Com base dos resultados obtidos, há como admitir que a nalbufina 1% não alterou o padrão de expressão da MMP-1, da MMP-9 e do OGF em córneas de coelhos submetidas à ceratectomia lamelar. .

Two forgotten induction agents; etomidate versus thiopental sodium with rocuronium for rapid sequence induction

To assess the effect on intubating conditions and haemodynamic response on intubation of two different induction agents etomidate and thiopental sodium with rocuronium during rapid sequence induction. This prospective quasi experimentalstudy was conducted in Department Of Anaesthesia, SICU and Pain Management, Dow Medical College, Civil Hospital Karachi and Abbasi Shaheed Hospital Karachi Medical and Dental College over a period of one year. Total 120 American Society of Anaesthesiologists [ASA] physical class I and II, adult patients of either gender, aged between 18 to 60 years, undergoing elective surgery were allocated randomly into two equal groups to receive either intravenous thiopental sodium [Group NTR] or etomidate[Group NER] for rapid sequence induction. Group NER was given nalbuphine 0.1 mg/kg, induction agent etomidate 3 mg/kg with muscle relaxant rocuronium 1.0 mg/kg while in group NTR induction agent thiopental sodium was given in the dose of 4 mg/kg with nalbuphine and rocuronium in the same doses. After sixty seconds, laryngoscopy was done. Intubating condition was assessed using the criteria of Cooper and colleagues: ease of intubation, condition of vocal cords and response to intubation. Cardiovascular response on intubation in terms of systolic and diastolic blood pressure and heart rate was evaluated at 0,1, 3 and 5 minutes. Demographic data were comparable between the groups. Intubating conditions which were assessed in terms of ease of laryngoscopy, condition of vocal cords at intubation and intubation response coughing, bucking and diaphragmatic movement were significantly better in the group NER [p<0.05]. Similarly, arterial blood pressure remained close to base line in NER group but there was significant fall in both systolic and diastolic blood pressure in group NTR. However, there was no significant difference in change in the heart rate in the groups. Etomidate-rocuronium is better than thiopental-rocuronium in terms of intubating conditions and haemodynamic stability during rapid sequence induction in non-septic surgical patients in emergency department

Combination of opioid agonist and agonist-antagonist admixtures for postoperative pain relieve after upper abdominal surgery

Nalbuphine, a mixed agonist-antagonist opioid, has a potential to attenuate the mu-opoid effects and to enhance the kappa-opioid effects. However, when morphine and nalbuphine are mixed together, the clinical interactions in different combining ratios on analgesic effect and adverse events are unknown. This study was designed to evaluate the interaction of combining different ratios of morphine and nalbuphine in i. v boluses for postoperative pain relieve in upper abdominal surgery and their effects on pulmonary function. This study enrolled 75 patients aged between 18 and 65 yr with an ASA physical status I and II underwent upper abdominal surgery under general anesthesia Patients were allocated randomly into one of five groups: In group I, 10 mg morphine were added into normal saline to a total of 10 ml [concentration of [morphine] [nalbuphine] =1/0 mg/ ml; pure morphine]. In group II, 7.5 mg morphine and 2.5 mg nalbuphine morphine: nalbuphine=3:1]. In group III, 5 mg morphine and 5 mg nalbuphine ratio of morphine: nalbuphine=1: 1]. In group IV, 2.5 mg morphine and 7.5 mg nalbuphine were added morphine: nalbuphine=1:3,]. In group V 10 mg nalbuphine were added into normal saline to a total of 10 ml morphine: nalhuphine=0: 1 mg /ml; pure nalbuphine]. Patients received standard general anesthetic technique without premedication, Postoperative analgesia was commenced with a loading dose of 3 ml solution i. v. immediately after patient recovery. The boluses of the drug were given on the patient request 1 ml/bolus. Pain intensity was evaluated with a 0-10 VAS at rest [1 hour after loading dose then at 2, 4, 12 and 24 hours] and upon movement [during coughing or changing body position from supine to lateral on bed]. FVC, FEV1 and /FEVI /FVC were measured by spirometry [SPIRO 601] preoperatively, immediately postoperatively [1h after loading dose] and 24 h postoperatively [on discharge]. Arterial pH, PaCO2 and PaO2 were measured preoperatively, immediately postoperatively and 24 hours postoperatively [on discharge]. Nausea, vomiting and pruritus were recorded by incidence. Sedation was reported using the Ramsay sedation score. Treatment failures were considered to be: Insufficient analgesia was de fined as VAS >4 at rest during 4-24 h after operation. Adjunctive analgesic with i.v. meperidine 50 mg or ketorolac 30 mg was given for insufficient analgesia. Intolerable nausea and vomiting were defined as persistent nausea or vomiting episodes that required more than three administrations of antiemetic [metoelopromide]. Intolerable Pruritus was defined as persistent Pruritus that required more than three administrations of antipruritics [diphenhydramine] Twenty-four hour analgesic requirements were similar among the five studied groups. Verbal analogue scores far pain were statistically similar among the five groups. The incidences of pruritus, nausea, and vomiting were higher in Group I than in other groups. There were no significant differences between the five groups as regards the incidences and severity of sedation. Pulmonary function tests [FVC and FEVI] were decreased significantly from the preoperative base line value to the immediately postoperative value and values after 24 hours in the five groups, while FEVI/FVC ratios increased significantly in the two postoperative times intervals compared to the baseline value. There were no significant differences in between the five groups. The effects of adding morphine and nalbuphine in admixture on analgesia far upper abdominal surgery is additive. Combinations of morphine and nalbuphine decreased the incidence of pruritus, nausea and vomiting. This may provide a novel combination strategy of opioid agonist and agonist-antagonist for postoperative pain management

Feto-maternal outcome; comparison while using epidural analgesia versus parenteral opioid derivatives in labour

To compare the effects of epidural analgesia and parenteral nalbuphine in labouring women with term pregnancies on feto-maternal outcome. Randomized controlled trial. It was carried out in the Labour Room, Nishtar Hospital, Multan From June 2009 to December 2009. A total of 60 patients were included in the study. Patients were divided into two groups, having 30 patients in each group. In group-A, pain control was much better and satisfactory [VAS=00-1], duration of labour was slightly prolonged and instrumental delivery was more common. Low Apgar score and birth asphyxia were seen in group-B. No baby developed RDS in both groups. Feto-maternal outcome is much better in women having epidural analgesia with bupivacaine as compared to women having intramascular nalbuphine

Nalbuphine added to intrathecal morphine in total knee arthroplasty; effect on postoperative analgesic requirements and morphine related side effects

Intrathecal morphine is widely used for postoperative pain control in major orthopaedic surgery. However, its use is associated with frequent side effects. Aim of the work was to investigate the effects of intrathecal coadministration of nalbuphine with intrathecal morphine on morphine related side effects and postoperative analgesic requirements. In this study, the intrathecal addition of 1 mg nalbuphine hydrochloride to a combination of 3 ml hyperbaric bupivacaine 0.5% and 0.2 mg morphine sulfate was tried in patients undergoing total knee arthroplasty. Patients who received intrathecal nalbuphine suffered significantly less than the control group from vomiting and pruritus meanwhile there was no effect on the postoperative analgesic requirements or the incidence of urinary retention. Intrathecal addition of nalbuphine to morphine decreased the opioid related side effects without affection of postoperative analgesia. The addition of nalbuphine to morphine intrathecally decreases the opioid related side effects without affection of postoperative analgesia. This combination can improve postoperative pain management in patients undergoing knee surgery under spinal anaesthesia

The preemptive analgesic effect of nalbuphine in pediatric adenoidectomy or tonsillectomy

BACKGROUND: The effectiveness of preemptive analgesia is still controversial. This study was designed to compare the effects of nalbuphine used in the pre-anesthesia period and after surgery for pain control when performing adenoidectomy or tonsillectomy in children. METHODS: Two hundreds four patients (aged 3 to 12 years) were randomly allocated into two groups: the preemptive group (group P, n = 98) and the intraoperative group (group I, n = 106). Nalbuphine 0.1 mg/kg was administered into the patients before induction of anesthesia in group P and it was injected at least 10 minutes after the beginning of surgery in group I. The anesthesia was performed in the conventional fashion. The pain score, the sedation score and the agitation score were checked and recorded in the postanesthetic room (PAR) at arrival (0), at 15 minutes and at 30 minutes. RESULTS: The pain scores for PAR 0, 15 and 30 minutes were significantly lower in group I than those in group P. The other sedation scores or agitation scores were similar in both groups. CONCLUSIONS: Nalbuphine used during the pre-anesthetic period was less effective than that used in the intraoperative period for pain control when performing adenoidectomy or tonsillectomy in children.

Effect of epidural analgesia on cesarean section in nulliparous women

BACKGROUND: The effect of epidural analgesia for labor on obstetric outcome is controversial. The purpose of this study is evaluating the influence of epidural analgesia on cesarean section in nulliparous women. METHODS: We retrospectively investigated 979 nulliparous women ASA graded I - II. EPI (n = 230) was received epidural analgesia with 0.2% ropivacaine and 75microgram fentanyl. N-EPI (n = 749) was received no epidural analgesia but nalbuphine 10 mg intramuscularly. We compared the rate and causes of cesarean section, instrumental delivery rate and fetal outcomes between EPI and N-EPI. RESULTS: Cesarean section rate was not different between the EPI (18%) and N-EPI (23%). Causes of cesarean section were progress failure (83% in EPI and 80% in N-EPI) and fetal distress (17% in EPI and 20% in N-EPI) and there were no differences between two groups. Instrumental delivery rate was higher in EPI (8%) than N-EPI (5%). Fetal outcome was not different between two groups. CONCLUSIONS: Epidural analgesia did not increase cesarean section rate and did not influence on causes of cesarean section. But epidural analgesia increased the vacuum delivery rate.

Prophylactic intravenous ondansteron and nalbuphine for reduction of subarachnoid fentanyl-induced pruritus in patients undergoing elective cesarean delivery

Addition of fentanyl to spinal anaesthesia with bupivacaine improves the quality and success of anaesthesia. However, it has a frequent incidence of pruritus and a substantial incidence of nausea and vomiting. tn this placebo controlled study, we compared the prophylactic efficacy of ondansetron and nalbuphine for the prevention of intrathecal fentanyl-induced pruri tus after cesarean delivery. Ninety elective parturients were assigned to one of the groups: Group 0 [Ondansetron 8mg IV n=30], Group N [Nalbuphine 4mg IV n=30] and Group S [Saline 0.9% IV n=30] as placebo. The study drugs were administered immediately after the umbilical cord was clamped. The occurrence of pruritus, nausea, pain and adverse reactions from ondansetron and nalbuphine was evaluated by pruritus score, 4-point rating score and visual analog scale respectively, at 15 minutes in the first hour after the injection of the study drugs. Afterward, evaluations were performed at 1, 2, 3 and 4 hours after the administration of study drugs. The overall incidence of pruritus, it was significantly more frequent in Group S [62%] compared with both Group 0 [43%] and Group N [42.5%]. The incidence of pruritus during the different study intervals showed significant increase in Group S compared with the other groups mainly at 45mm and 1 hour. The pruritus score was significantly different between Group 0 and Group S and between Group N and Group S [p<0.0S] respectively, it was mostly mild in Group 0 and Group N and mostly moderate in Group S. Treatment for pruritus was requested by patients in, 10%, 11% and 29% of patients in the Group 0, Group N and Group 5, respectively. There was no significant difference in the overall incidence and the severity of nausea andlor vomiting at different time study intervals for all groups. However, the number of patients requesting treatment for nausea and/or vomiting was significantly less in Group 0 and Group N when compared with Group S. No significant adverse reactions related to the study drugs reported during the different study intervals. Although IV ondansetron and nalbuphine significantly decreased the incidence of of fentanyl-induced pruritus more than placebo after cesarean delivery, further studies are recommended to show the other possible mecha nisms might be involved in the pathogenesis of fentanylinduced pruritus

Effect of Nalbuphine on Emergence Agitation and Recovery after Desflurane Anesthesia in Children for Strabismus Surgery / 대한마취과학회지

BACKGROUND: Emergence agitation frequently occurs after desflurane anesthesia in children.Nalbuphine, because of its sedative and analgesic properties, might be useful for the management of this side effect.We studied the effect of nalbuphine on recovery characteristics and emergence agitation after desflurane anesthesia in children for strabismus surgery. METHODS: 41 patients (3-14 yr) scheduled for pediatric strabismus surgery were included.All children received ketamine 0.5 mg/kg intravenously before entering the operating room.After intravenous induction with thiopental and rocuronium to facilitate endotracheal intubation, patients were randomly assigned to receive saline, or nalbuphine 0.2 mg/kg respectively. Anesthesia was maintained with desflurane 4-6% with N2O : O2 = 2 : 1.At the end of anesthesia, time to cough, extubation, movement, eye opening and discharge were recorded.Emergence agitation was recorded by three point rating scale. RESULTS: Agitation scores were significantly different between the two groups (P < 0.01).Time to extubation and movement were similar between two groups.Time to eye opening was significantly increased in nalbuphine group (P < 0.05).But, there was no difference in time to discharge from the recovery room to the ward between the two groups. CONCLUSIONS: In children undergoing strabismus surgery with desflurane anesthesia, nalbuphine 0.2 mg/kg administered immediately after induction reduced incidence of emergence agitation without delaying discharge from recovery room.

Effects of propofol and nalbuphine on emergence agitation after sevoflurane anesthesia in children for strabismus surgery / 대한마취과학회지

BACKGROUND: Emergence agitation in children is frequently associated with sevoflurane general anesthesia. We measured the effects of propofol and nalbuphine on emergence agitation after sevoflurane anesthesia in children for strabismus surgery. METHODS: Ninety pediatric patients receiving sevoflurane anesthesia for elective strabismus surgery were enrolled. They were randomized to receive either saline (Group S), propofol 1 mg/kg (Group P), or nalbuphine 0.1 mg/kg (Group N) at the end of surgery. We evaluated the incidence of emergence agitation and recovery in the postanesthesia care unit. RESULTS: The time to recovery was similar between the three study groups. The incidence of agitation was significantly lower in Group N compared with Group S, but the incidence of agitation between Group S and Group P was not different. CONCLUSIONS: Nalbuphine 0.1 mg/kg at the end of strabismus surgery under sevoflurane anesthesia effectively reduced emergence agitation in children without delaying recovery, but propofol did not.

Effects of propofol and nalbuphine on emergence agitation after sevoflurane anesthesia in children for strabismus surgery / 대한마취과학회지

BACKGROUND: Emergence agitation in children is frequently associated with sevoflurane general anesthesia. We measured the effects of propofol and nalbuphine on emergence agitation after sevoflurane anesthesia in children for strabismus surgery. METHODS: Ninety pediatric patients receiving sevoflurane anesthesia for elective strabismus surgery were enrolled. They were randomized to receive either saline (Group S), propofol 1 mg/kg (Group P), or nalbuphine 0.1 mg/kg (Group N) at the end of surgery. We evaluated the incidence of emergence agitation and recovery in the postanesthesia care unit. RESULTS: The time to recovery was similar between the three study groups. The incidence of agitation was significantly lower in Group N compared with Group S, but the incidence of agitation between Group S and Group P was not different. CONCLUSIONS: Nalbuphine 0.1 mg/kg at the end of strabismus surgery under sevoflurane anesthesia effectively reduced emergence agitation in children without delaying recovery, but propofol did not.

comparative study between lidocaine spray [10%] and lidocaine spray plus intravenous nalbuphine to facilitate laryngeal mask airway insertion in minor gynecological procedures

Background: This prospective, randomized, double blind study was designed to evaluate the effect of adding nalbuphine [mixed agonist antagonist opioid] to lidocaine spray [10%] on the hemodynamics as well as the laryngeal mask airway insertion conditions in patients scheduled for elective minor gynecological procedures

Methods: Forty adult female patients, ASA physical status I-II subjected for elective minor gynecological procedures at Mansoura University Hospital were enrolled in this study. Patients were randomly assigned using sealed envelope method into two groups [n= 20 for each group]. One group received lidocaine spray 10% in the oral cavity and oropharynx before LMA insertion while the other group received lidocaine spray in addition to IV nalbuphine 0.2 mg/kg. Anesthesia was induced in all patients with propofol injection in a sleep inducing dose [1-2 mg.kg-1], titrated to loss of consciousness with oxygen mask. Anesthesia was maintained with 1% isoflurane, nitrous oxide [60%] and oxygen [40%]. The following data were recorded during LMA insertion, six variables were noted on a 3-points scale, jaw relaxation [good-incomplete-poor], ease of insertion [easy-difficult-impossible], swallowing [nil-slight-gross], coughing/gagging [nil-slight-gross], limb movement [nil-slight-gross], laryngospasm [nilslight-gross] and blood pressure [MPB], heart rate [HR] and peripheral arterial oxygen saturation [basal and every one minute for 5 minutes]. Patients were monitored with electrocardiogram, noninvasive arterial blood pressure, pulse oximetry and capnogram. All noted and recorded before induction[basal] and every minute for 5 minutes

Results: As regard LMA insertion characteristics, there was statistical significance observed between both group in coughing/gagging and laryngospasm [p= 0.003 and 0.018respectively] favoring nalbuphine with lidocaine group. Comparison of hemodynamic parameters between groups has shown that nalbuphine plus lidocaine group had generally better control of blood pressure throughout and shortly after the insertion procedure. In addition, this group had significantly better control of heart rate in two time stations and remained better later in spite of lack of statistical significance

Conclusion: Nalbuphine administration with lidocaine spray has the advantage of better control of hemodynamics and improved some laryngeal mask airway insertion criteria like significant decrease in coughing/ gagging and laryngospasm. We can conclude that IV nalbuphine is a safe and cheap opioid that can be used for facilitation of LMA insertion

effect of epidural nalbuphine and morphine versus systemic nalbuphine with epidural morphine in patients submitted for major abdominal surgery

In this double blind randomized study we compared. The effects of epidural nalbuphine to intravenous [IV] nalbuphine on the epidural morphine in patients undergoing elective major abdominal surgery. G[M] [control group] received epidural mixture of bupivacaine 0.5% 1mg/kg and preservative free morphine 150 micro g/ml bupivacaine G[M-epiN] received epidural mixture of bupivacaine 0.5% 1mg/kg and preservative free morphine 150 micro g /ml bupivacaine and preservative and buffer free nalbuphine 30 micro g/mL bupivacaine G[MivN] received epidural mixture of bupivacaine 0.5% 1mg/kg and preservative free morphine 150 micro g/ml bupivacaine and preservative and buffer free nalbuphine 0.1mg/kg [IV] There was no significant changes in analgesia score or sedation score between 3 groups. Nalbuphine markedly adverse the side effects of morphine regarding haemodynamics. There was significant decrease in HR and MAP in the G[M-epiN] G[MivN] groups comparing with G[M]. Our data indicate that the addition of nalbuphine either intra venous or epidurally prevent the morphine induced side effects without reversing its analgesic effect

Post-operative pain; multi-modal analgesia technique is superior to conventional single analgesia

To compare the efficacy of a multi-modal analgesic regime with conventional single drug analgesic therapy after total abdominal hysterectomy under general anaesthesia. Prospective, random clinical trial. A 250 bedded secondary care hospital. From march 2006 to September 2006. In this study, forty ASA 1-2 middle aged females presenting for elective total abdominal hysterectomy were randomized to receive multi modal pain treatment with oral celecoxib, intravenous tramadol, incisional bupivacaine and intramuscular diclofenac sodium until hospital discharge [Group I] or conventional therapy with intravenous nalbuphine peri and post-operatively [Group II]. Both groups received general anaesthesia. Visual analog pain score was recorded in recovery room, then 4 hourly during the first 12 hr, and then 6 hourly for next 12 hours. Post-operative analgesia was managed with diclofenac sodium 75mg im and nalbuphine 10mg im every 6 hourly in respective groups. Request for additional analgesic was noted and dealt accordingly. Incidence of side effects and surgical complications were recorded. In the recovery room only one patient of Group one [multi-modal group] [n=20] experienced severe pain as compared to 4 patients of group two 'single analgesic group [n=20] [5% vs, 40%]. In next 24 hours, pain score were considerably lower in group one as compared to group two. After 24 hours 15 patients had no pain on VRS as compared to 11 patients [75% vs. 55%]. Four patients of group two needed rescue analgesia while none of multi-modal group demanded it. Incidence respiratory depression, nausea and vomiting were also lower in multi-modal group. Multimodal analgesic regime is an effective tool in reducing the postoperative pain after major gynaecological surgery. By employing multimodal analgesic technique incidence of side effects like respiratory depression, nausea and vomiting were also reduced and patient satisfaction was more