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Objective:To evaluate the optimization efficacy of ropivacaine mixed with nalbuphine for epidural labor analgesia through comparison with ropivacaine mixed with sufentanil in primiparas.Methods:Four hundred and forty primiparas with a singleton fetus in vertex presentation without abnormal fetus, aged 19-36 yr, at 37-42 weeks of gestation, who were suitable and volunteered to receive epidural labor analgesia, were selected and randomly divided into observation group (NR group, n=220) and conventional group (C group, n=220).Epidural labor analgesia solution contained nalbuphine 40 mg and ropivacaine 120 mg in 150 ml of normal saline in group NR.Epidural labor analgesia solution contained sufentanil 50 μg and ropivacaine 120 mg in 150 ml of normal saline in group C. The analgesia pump was set up to deliver a 5 ml bolus dose with a 20-min lockout interval, programmed intermittent bolus 10-15 ml/h and background infusion at 2 ml/h after an initial dose of 15 ml to maintain VAS score <3.The length of labor, adverse reactions during labor analgesia, neonatal Apgar score, parameters of umbilical artery blood gas analysis and neonatal behavioral neurological assessment score were recorded. Results:Compared with group C, the incidence of urinary retention, pruritus, nausea and vomiting and fever at birth was significantly decreased in group NR ( P<0.05).The duration of the first and second stages of labor, neonatal Apgar score, pH value of umbilical artery blood, lactate concentrations, and neonatal behavioral neurological assessment score were within the normal range in both groups, and there was no significant difference between the two groups ( P>0.05). Conclusions:Compared with conventional medication, nalbuphine mixed with ropivacaine has the same efficacy when used for epidural labor analgesia in primiparas, but it has a certain optimization efficacy in terms of safety.
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Objective:To evaluate the safety of naborphine hydrochloride combined with propofol in painless colonoscopy diagnosis and treatment of hypertensive patients.Methods:From October 2018 to September 2020, 900 patients with ASA grade Ⅰ to Ⅲ, aged 18 to 65, who underwent colonoscopy in Zhuhai Hospital Affiliated to Jinan University and Shanghai East Hospital Affiliated to Tongji University were prospectively selected. According to the random number table method, the patients were divided into 3 groups ( n=300): naborphine hydrochloride group 1 (N1 group, intravenous injection of 0.05 mg/kg naborphine hydrochloride); naborphine hydrochloride group 2 (N2 group, intravenous injection of 0.1 mg/kg naborphine hydrochloride); sufentanil group (SF group, intravenous injection of 0.1 μg/kg sufentanil). During anesthesia induction, propofol was combined with sedation, and the dose of propofol was 1.5 mg/kg. The systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), pulse oxygen saturation (SpO 2), respiratory rate (RR), and mean arterial pressure (MAP) of the three groups were compared before anesthesia (T 0), during induction (T 1), 1 min after induction (T 2), 2 min after induction (T 3), 3 min after induction (T 4) and 4 min after induction (T 5), and the bispectral index (BIS) were monitored. At the same time, the examination time, total dosage of propofol, recovery time, postoperative Visual Analogue Scale (VAS) score and perioperative anesthesia related adverse reactions of the three groups were compared. Results:There was no significant difference among the three groups in examination time, total dosage of propofol, recovery time, postoperative VAS score and adverse anesthetic reactions (all P>0.05). There was no significant difference in HR, SpO 2 and RR among the three groups at different time points (all P>0.05). The SBP, DBP and MAP in N1 group at T 1, T 3, T 4 and T 5 were lower than those in SF group (all P<0.05); The SBP, DBP and MAP in N2 group at T 1, T 3 and T 4 were higher than those in N1 group (all P<0.05). The BIS in T 3 and T 4 of N2 group was higher than that of N1 group (all P<0.05). Conclusions:0.1 mg/kg naborphine hydrochloride combined with propofol for painless enteroscopy in patients with hypertension has fine anesthetic effect and safety.
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Objective:To assess the value of nalbuphine intravenously injected before epidural labor analgesia in inhibiting uterine contraction pain in primiparae.Methods:A total of 140 expectant primiparae who were suitable and willing to receive epidural labor analgesia with a singleton fetus in vertex presentation, aged 20-40 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅱ, with their cervical dilation of 2-3 cm, were divided into nalbuphine group (N group) and routine control group (C group), with 70 cases in each group.Group N received intravenous injection of nalbuphine 0.1 mg/kg (in normal saline 5 ml) at 10 min before epidural puncture, while group C received intravenous injection of the equal volume of normal saline at 10 min before epidural puncture.The epidural puncture-related items including the intensity of pain (Numeric Rating Scale [NRS] scores) and degree of sedation-agitation (Riker sedation agitation scores) during uterine contraction, duration of epidural procedure, parturients′ satisfaction with epidural puncture, successful epidural catheterization at first attempt and complications (nerve paraesthesia and inadvertent intravascular punctures) were recorded.Results:Compared with group C, the NRS scores and Riker scores for uterine contraction pain were significantly decreased during epidural procedure ( P<0.05), with NRS score <6 and Riker sedation agitation scores of 4, the duration of epidural puncture was shortened, the success rate of epidural puncture at first attempt was increased(51%/70%), and the incidence of nerve paraesthesia and inadvertent intravascular puncture was decreased(17%/6%, 14%/4%), and the parturients′ satisfaction with epidural puncture was increased in group N ( P<0.05). Conclusions:Nalbuphine 0.1 mg/kg intravenously injected before epidural labor analgesia can safely and effectively reduce uterine contraction pain without limb agitation, which is helpful in implementating epidural puncture in primiparae.
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Objective:To preliminarily evaluate the effectiveness and safety of nalbuphine for patient-controlled intravenous analgesia (PCIA) after cesarean section.Methods:This study was a single arm clinical trial.Sixty parturients, aged 20-44 yr, weighing 50-80 kg, of American Society of Anesthesiologists physical status ⅠorⅡ, scheduled for cesarean section with epidural anesthesia, were enrolled in this study.PCIA was performed when visual analogue scale (VAS) score for postoperative pain ≥3 points following cesarean section.A bolus of nalbuphine 10 mg was intravenously injected as a loading dose.PCIA pump solution contained 110 mg nalbuphine diluted to 200 ml with normal saline.The pump was set up with a background infusion at a rate of 4 ml/h, 2 ml bolus dose and 15 min lockout interval.The VAS scores for pain at rest and during activity and uterine contraction pain, Ramsay sedation scores and adverse reactions were observed within 48 h after surgery.Results:The VAS scores for pain at rest and during activity and uterine contraction pain were all ≤3 points, the Ramsay scores were maintained at 2-4 points, hemodynamic parameters were maintained in the normal range, and no adverse reactions such as nausea and vomiting, drowsiness, hyperhidrosis, dizziness, pruritus, and respiratory depression occurred.Conclusion:PCIA with nalbuphine given according to the method mentioned above has good feasibility when used for analgesia following cesarean section.
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Objective:To investigate the efficacy and safety of naborphine versus dezocine in painless visual anesthetics induced abortion. Methods:A total of 120 patients who underwent painless visual anesthetics induced abortion in Zhongshan City People's Hospital and Zhongshan Shaxi Longdu Hospital, China during January to September in 2020. They were randomly assigned to receive intravenous naborphine hydrochloride injection (0.15 mg/kg, naborphine group) or dezocine injection (5 mg, dezocine group), followed by intravenous propofol (2 mg/kg). When the eyelash reflex disappeared, surgery was initiated. If there were body movements, 30-50 mg propofol was added as appropriate. Systolic blood pressure, diastolic blood pressure, blood oxygen saturation, and heart rate before anesthesia (T 0), at 3 minutes after the beginning of surgery (T 1), and during recovery (T 2) were compared between the two groups. The time to regain consciousness, postoperative visual analogue pain score, propofol dose, operative time, and adverse reactions were determined in each group. Results:There were slight, but not significant, differences in systolic blood pressure and heart rate between the two groups at T 0, T 1 and T2 (all P > 0.05). There were no significant differences in time to regain consciousness, postoperative visual analogue pain score, propofol dose and operative time between the two groups (all P > 0.05). The incidence of nausea and vertigo in the naborphine group was 8.3% (5/60) and 11.6% (7/60), respectively, which was significantly lower than that in the dezocine group [30.0% (18/60), 31.6% (19/60), χ2 = 9.09, 7.07, both P < 0.05). Conclusion:Naborphine combined with propofol for painless visual anesthetics induced abortion exhibits good anesthetic effects and safety, with fewer intraoperative and postoperative adverse reactions than dezocine combined with propofol.
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Objective:To investigate the postoperative analgesic efficacy of nabuprofen combined with femoral nerve block in older adult patients subjected to knee arthroplasty and its effects on cognitive function and serum S-100β protein level.Methods:Ninety-one older adult patients subjected to knee arthroplasty between March 2018 and March 2020 in Zhoushan Hospital of Traditional Chinese Medicine were included in this study. They were randomly divided into observation ( n = 45) and control ( n = 46) groups. Patients in both groups received femoral nerve block and catheterization. Naborphine and equal amount of 0.9% sodium chloride injection were intravenously administered in the observation and control groups, respectively for postoperative analgesia. Before and after surgery, Mini-Mental State Examination (MMSE) score, S-100β protein level and Visual Analogue Scale score, and adverse reactions were compared between the observation and control groups. Results:Before surgery, there was no significant difference in MMSE score between the two groups ( P > 0.05). At 3 days after surgery, MMSE score in each group was significantly decreased compared with before surgery (both P < 0.05). At 3 days after surgery, MMSE score in the observation group was significantly higher than that in the control group [(25.34 ± 1.31) points vs. (23.67 ± 1.53) points, t = 5.34, P < 0.05]. Before surgery, there was no significant difference in serum S-100β protein level between the two groups ( P > 0.05). At 1 and 3 days after surgery, serum S-100β protein level in each group was significantly increased compared with before surgery (both P < 0.05). At 7 days after surgery, serum S-100β protein level in each group recovered to pre-operative level. At 1 and 3 days after surgery, serum S-100β protein level in the observation group was significantly lower than that in the control group ( t = 10.20, 9.21, both P < 0.05). At 1, 3, 6, 12 and 24 hours after surgery, the Visual Analogue Scale score in the observation group was (1.14 ± 0.22) points, (1.43 ± 0.25) points, (1.87 ± 0.21) points, (3.56 ± 0.20) points, and (2.63 ± 0.23) points respectively, which was significantly lower than that in the control group [(2.53 ± 0.24) points, (2.53 ± 0.24) points, (3.56 ± 0.20) points, (3.98 ± 0.25) points, (4.23 ± 0.21) points, t = 5.10, 8.15, 9.41, 10.18, 11.42, all P < 0.05]. The incidence of adverse reactions in the observation group was significantly lower than that in the control group [13.33% (6/45) vs. 30.43% (14/46), χ2 = 3.88, P = 0.049]. Conclusion:Naborphine combined with femoral nerve block can effectively improve the postoperative cognitive function of older adult patients undergoing knee arthroplasty, provides good postoperative analgesia, and is highly safe.
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AIM: To observe the anesthetic effect of nalbuphine used in ultrasound-guided transvaginal oocyte retrieval and its effect on embryo quality and pregnancy outcome. METHODS: Four-hundred patients who underwent ultrasound-guided transvaginal oocyte retrieval were randomly divided into two groups (n=200): nalbuphine group (N group) and control group (C group). The patients were in the bladder lithotomy position. Patients in N group were given nalbuphine 0.1 mg/kg intravenously 2 minutes before induction of anesthesia, patients in C group were given normal saline intravenously, and patients in both groups were induced with propofol 1.5 mg/kg. The patients were kept breathing spontaneously, and they were given intravenous injections of propofol (2 mg•kg
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Saddle block is the most commonly used anaesthetic technique for perianal surgeries in adults. Perianal surgeries under saddle block are considered as day care surgeries. Major disadvantage is that the low volume of spinally given drug won’t prolong duration of postoperative analgesia. Inj. Dexmedetomidine (α2-Adrenoceptor agonist) and Inj. Nalbuphine (opioid agonist-antagonist) were studied as an adjuvant as to whether they increase the duration of post-operative analgesia. Secondary objectives of this study were to compare hemodynamic stability and side effects among Inj. Dexmedetomidine and Inj. Nalbuphine. METHODSA total of 60 patients with American Society of Anaesthesiologist physical Status I and II scheduled for elective perianal surgeries were randomly allocated into two equal groups in this randomized prospective comparative study. Group D received 0.5% hyperbaric bupivacaine 0.8 mL + 5 mcg dexmedetomidine and group N received 0.5% hyperbaric bupivacaine 0.8 mL + 0.6 mg nalbuphine. Onset and duration of sensory and motor blockade, and duration of analgesia were recorded. Post-operative analgesic consumption and side effects were studied for 24 hours. Statistical analysis was done by using descriptive and inferential statistics using Chi- square test and Student’s t-test. RESULTSDemographic characteristics, duration of surgery, onset of sensory and motor block were comparable. Duration of analgesia was 320.26 ± 89.52 min for dexmedetomidine (D) whereas it was 222.23 ± 25.43 min for nalbuphine (N) with a P value of <0.05. No side effects were noted. CONCLUSIONA dose of 5 mcg dexmedetomidine as an adjuvant seems to be optimal for providing postoperative analgesia with better hemodynamic stability.
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Epidural analgesia has been the gold standard, preferred technique for providing postoperative analgesia in lower abdominal, lower limb, pelvic and vascular surgeries. Combination of local anaesthetic agents when used along with opioids, as an adjuvant in epidural analgesia, was found to be effective and synergistic. Ropivacaine is associated with less central nervous system toxicity and cardiotoxicity, and produces less motor blockade. Nalbuphine is an opioid with mixed kappa (κ) agonist and mu (µ) antagonistic properties, when mixed with other opioids, attenuates the µ opioid effect and enhances the κ opioid effect. We wanted to compare the post-surgical analgesic efficacy of epidural nalbuphine (10 mg) when added as an adjuvant to epidural ropivacaine (0.2%-9 ml) in patients undergoing lower abdominal surgeries. Primary objective was to compare the duration of postoperative analgesia and number of rescue analgesics required in 24 hours. Secondary objectives were to compare postoperative haemodynamic variation, quality of analgesia, Visual Analogue Score and side effects if any in both the groups.METHODSIt was prospective observational study conducted after obtaining ethical committee clearance. Sixty patients of ASA class I & II, fulfilling inclusion criteria posted for elective lower abdominal surgeries preferably abdominal hysterectomies divided into two groups, each comprising of 30 patients; group R- Ropivacaine- 0.2% - 9 ml with 1 ml normal saline and group R+N - 0.2%- 9 ml with nalbuphine 1 ml - 10 mg, under spinal anaesthesia with epidural catheter insertion. Parameters like duration of analgesia, number of rescue analgesia, quality of analgesia by patient rated quality of pain management, haemodynamic variation was assessed. Assessment of pain was done by VAS scale, side effects like sedation was assessed by modified Ramsay sedation scale.RESULTSNo demographic variation was found in any group. Mean duration of analgesia was found more in group R+N. Number of rescue analgesia was reduced in group R+N with improved quality of analgesia which was statistically significant. Mean HR was significant in group R+N. No change was noted in SBP, RR, SpO2 in either group. DBP and MAP showed statistically significant difference at 30, 60 min and 15, 30, 60 min respectively. None of the patients in either group had sedation; one episode of vomiting was noted in group R+N with statistically non-significant results.
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Background and Aims: The benefit of post-operative analgesia in regional block is short lived due to limited duration of theaction of local anesthetics. Various adjuvants have been tried to enhance the duration of analgesia. The aim of this study wasto evaluate the analgesic efficacy and safety of nalbuphine as an adjuvant to 0.5% ropivacaine for supraclavicular brachialplexus block.Materials and Methods: A prospective, randomized, double-blind study was conducted on 60 patients of American Societyof Anesthesiologists physical Status I/II aged 18–60 years scheduled for upper limb surgeries under supraclavicular brachialplexus block. The patients were randomly allocated into two groups of 30 each to receive either 30 ml of 0.5% ropivacainewith 1 ml of normal saline (Group R) or 30 ml of 0.5% ropivacaine with 1 ml (10 mg) of nalbuphine (Group RN). The onset andduration of sensory and motor block, duration of analgesia, and side effects were noted.Results: The mean onset time for a complete sensory and motor block in Group RN was shorter (8.37 ± 0.79 min; 17.67 ± 1.07 min)as compare to Group R (10.9 ± 1.11 min; 19.17 ± 0.86 min). The mean duration of sensory and motor block in Group RN waslonger (725.67 ± 16.06 min; 420.33 ± 14.94 min) as compare to Group R (473.0 ± 22.67 min; 359.67 ± 26.89 min). The meanduration of analgesia in Group RN was 846.33 ± 72.50 min and in Group R was 588.0 ± 27.37 min. All results were statisticallysignificant (P < 0.0001). No significant side effects were observed in any of the two groups (P > 0.05).Conclusion: Nalbuphine as an adjuvant to ropivacaine in the supraclavicular brachial block significantly shortens the onsettime for sensory and motor block and prolongs the duration of sensory and motor blocks with longer duration of post-operativeanalgesia.
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Background: Inguinal hernia repair is one of the common surgeries performed in general population under spinal anesthesia. Though Spinal anesthesia is relatively safe it has a short duration of action and can’t be used when the surgery is expected to be prolonged. To overcome this drawback various adjuvants are being increasingly used. Spinal anesthesia with 0.5% hyperbaric Bupivacaine, along with adjuvants, is routinely administered for lower abdominal surgeries. Intrathecal Nalbuphine added to Bupivacaine (0.5% Hyperbaric) has the potential to provide good intraoperative analgesia & prolongs early post-operative analgesia. Methods: 30 ASA I and II patients of age group 20-65 years, scheduled for inguinal hernia repair were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were randomized in two equal groups of 30 each. Group I patients received bupivacaine 0.5% heavy 3.1 ml + intrathecal nalbuphine 0.4 ml (0.4mg) whereas patients in group II received bupivacaine 0.5% heavy 3.1ml + 0.4ml NS. Onset of sensory and motor blockade, duration of analgesia, need for rescue analgesia, hemodynamic parameters and incidence of adverse effects was compared in both the groups. P value less than 0.05 was taken as statistically significant. Results: Demographic parameters such as gender, height, weight and BMI were found to be comparable in both the groups. Moreover, ASA grades, duration of surgery, Time of onset of sensory and motor blocks were also found to be comparable. Duration of sensory and motor block and duration of postoperative analgesia was found to be significantly more in group I as compared to group II. Hemodynamic parameters and incidence of side effects was found to be comparable in both the groups. Conclusion: Addition of nalbuphine to Bupivacaine in patients undergoing inguinal hernia repair under spinal anesthesia is associated with prolonged duration of sensory and motor blockade as well as reduced need for giving rescue analgesia without increase in incidence of side effects.
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Background: Airway manipulation and surgical stimulation lead to variable changes in hemodynamic profile due to increase in plasma catecholamine levels, but these changes can be attenuated by appropriate premedication. The present study was designed to compare the clinical efficacy of intravenous premedication of clonidine with nalbuphine on intraoperative hemodynamic profile of patients during surgery under general anaesthesia.Methods: Sixty adult consenting patients of ASA physical status I and II of either gender were randomized into two groups of 30 patients each, to receive either intravenous clonidine (2 μg/kg) or nalbuphine (0.2 mg/kg), 10 min before induction with propofol. Direct laryngoscopy and intubation were facilitated with vecuronium bromide. Changes in heart rate, blood pressure and electrocardiogram were recorded at specific time intervals and were noted as primary variable. Any adverse effects and complications were recorded as secondary outcomes.Results: After laryngoscopy and intubation, the increase in mean heart rate and mean blood pressure occurred immediately in patients of both groups, but persisted up to 6 to 10 min in patients of clonidine group, thereafter the changes returned back to baseline values, while in patients of nalbuphine group, this increase persisted up to 8 to 10 min. The differences in hemodynamic changes between the groups were statistically significant throughout the surgery and post extubation.Conclusions: Intravenous clonidine was more effective than nalbuphine to attenuate the hemodynamics changes during stressful period of laryngoscopy, intubation and surgery.
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Background: Various anaesthetic agents have been tried to attenuate pressor response to laryngoscopy and intubation. Among the recommended groups intravenous nalbuphine satisfies without much undesired effects. The objective was to study efficacy of two different doses of nalbuphine to attenuate pressor response to laryngoscopy and intubation.Methods: This was hospital based comparative study was carried out at Karnataka institute of Medical Sciences Hospital, Hubli, India. Patients were divided into two groups of 50 each randomly. First group was named as N1 and the second group was named as N2. Patients in N1 were given 0.1mg/kg Nalbuphine in 10ml of normal saline and patients in N2 were given 0.2-0.1mg/kg Nalbuphine in 10ml of normal saline. Appropriated statistical tests were applied like t test, ANOVA. P value if found less than 0.05 was recorded as statistically significant.Results: There was marked increase in HR, SBP, DBP and MAP immediately following laryngoscopy and intubation in the both the groups. Intravenous Nalbuphine given 5 minutes before intubation in the dose of 0.2mgkg-1 body weight effectively attenuated the hemodynamic response after laryngoscopy and intubation. However, there was a rise in HR, SBP, DBP and MAP immediately following intubation in group N2 which was clinically not significant though statistically significant. Side effects like nausea, vomiting, respiratory depression and sedation was not observed in both study groups.Conclusions: Authors concluded that 0.2mg/kg body weight dose of Nalbuphine was found to be more effective than 0.1mg/kg body weight dose of nalbuphine in maintaining the haemodynamics of the patients.
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Background: Subarachnoid block (SAB) is a widely used regional anesthetic technique for infraumbilical surgeries.Aims: The study was conducted to compare intrathecal nalbuphine with different doses of bupivacaine in infraumbilical surgerieswith respect to hemodynamic changes, side effects, onset and duration of sensory as well as motor blockade, and duration ofanalgesia.Materials and Methods: After obtaining Institutional Ethics Committee approval, a prospective study was conducted on90 patients belonging to American society of Anesthesiology Grades I and II, aged 18–60 years and scheduled for infraumbilicalsurgeries using SAB. Three Groups A, B, and C each with 30 patients were given 0.8 mg nalbuphine along with 10, 12.5, and15 mg of hyperbaric bupivacaine, respectively.Statistical Analysis: Chi-square and unpaired “t” test and following results were observed.Results: Mean onset of sensory block until T10 dermatome was 2.59 ± 0.43, 2.49 ± 0.30, and 2.44–0.33 min while its totalduration was 102.23 ± 5.81, 110.10.83 ± 83, and 136.33 ± 6.15 min in Groups A, B, and C. Maximum motor blockade wasachieved in 7.55 ± 0.57, 7.41 ± 0.51, and 7.30 ± 0.62 min and mean duration of motor block was 145.27 ± 11.80, 155.00 ± 11.58,and 188.00 ± 10.27 min in Groups A, B, and C. Mean time of total duration of the analgesia in Groups A, B, and C was 240.83 ±36.34, 413.77 ± 68.60, and 719.90 ± 99.93 min. Patients in Group C had hypotension at 8th and 10th min intraoperatively whileother parameters and side effects were non-significant.Conclusion: About 0.8 mg of nalbuphine when combined with 12.5 mg of hyperbaric bupivacaine had optimum duration ofanalgesia and sensory block with lesser hemodynamic alterations and side effects.
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Background: Adequate post-operative analgesia is the prime duty of anesthesiologist and several adjuvants have been usedalong with local anesthetics to prolong the duration of brachial plexus block. The present study aimed to compare the effect ofnalbuphine and magnesium sulfate as an adjuvant to ropivacaine and ropivacaine alone in nerve stimulator guided supraclavicularbrachial plexus block in patients scheduled for orthopedic upper limb surgeries.Materials and Methods: A total of 90 patients of in the age group of 20–65 years of either sex of the American Society ofAnesthesiologists Grade I and II were divided into three groups of 30 each. Group R received 30 ml of 0.75% ropivacaine alone,Group RM received 30 ml of 0.75% ropivacaine plus 150 mg of magnesium sulfate, and Group RN received 30 ml of 0.75%ropivacaine plus 20 mg of nalbuphine. All the groups were compared with respect to onset and duration of sensory and motorblockade, post-operative analgesia, need for rescue analgesia, hemodynamics, and side effects.Results: Onset of sensory and motor block was earliest in Group RN and was highly significant (P < 0.001) when compared toGroup R and Group RM. Mean duration of post-operative analgesia was 8.70 ± 1.18 h in Group R, 11.73 ± 1.23 h in Group RM,and 14.40 ± 1.25 in Group RN. Duration of sensory and motor block and post-operative analgesia were significantly prolonged(P < 0.001) both in Group RM and Group RN when compared to Group R.Conclusion: Both nalbuphine and magnesium sulfate are effective adjuvant as compared to ropivacaine alone as they prolong theduration of block as well as post-operative analgesia when used for supraclavicular brachial plexus block. However, nalbuphinehas proven to be a better adjuvant as compared to magnesium sulfate as it also results in earlier onset of sensory and motorblock and better patient and surgeon satisfaction scores.
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Objective: To observe the influence of preemptive analgesia by nalbuphine combined with flurbiprofen in the platelet activity indexes of the patients with decompensated cirrhosis, and to explore its quality of analgesia in the patients with decompensated cirrhosis. Methods: A total of 120 patients with decompensated cirrhosis were randomly divided into combination group (40 cases, given nalbuphine combined with flurbiprofen before anesthesia), nalbuphine group (40 cases, given nalbuphine before anesthesia) and flurbiprofen group (40 cases, given flurbiprofen before anesthesia). The postoperative patient-controlled intravenous analgesia (PCIA) was carried out with sufentanil in all the patients. The indexes of visual analog score (VAS), PCIA compression number, sufentanil consumption, Ramsay score, thrombelastogram (TEG) indexes (R value, K value, a angle, MA value and CI value) and the maximum aggregation rate by arachidonic acid (MARAA) and β-endorphin (β-EP) level, recovery time, and agitation occurrence rate of the patients in various groups were recorded 12 h and 24 h after operation. Results: The indexes of VAS, PCIA compression number, sufentanil consumption and 3-EP level of the patients in combination group were lower than those in the other groups 12 and 24 h after operation (P0. 05). The Ramsay scores of the patients in three groups had no differences at 12 and 24 h after operation (P>0. 05). Compared with nalbuphine group, the R values and K values of the patients in combination group and flurbiprofen group at 12 and 24 h after operation were increased (P 0. 05). The recovery time of the patients among three groups had no significant difference (F=2. 054, P=0. 102). The agitation occurrence rate during recovery period of the patients in case group was the highest (F=5. 624, P= 0. 001), and there was no significant difference in the agitation occurrence rate during recovery period of the patiens between nalbuphine group and flurbiprofen group (χ2 =3. 020, P=0. 091). Conclusion: Combination of nalbuphine and flurbiprofen in the patients with decompensated cirrhosis before analgesia can improve the quality of postoperative analgesia and can' t inhibit the activity of platelet obviously.
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Objective To investigate the effects of propofol combined with nalbuphine on diaphragmatic movement monitored by ultrasound in patients undergoing colonoscopy.Methods Forty patients, males 21 and females 19, aged 18-65 years, BMI 18-25 kg/m2, ASA physical status I or II, were recruited and scheduled to undergo elective painless colonoscopy.All patients were randomly divided into two groups (n =20):propofol group (group P) and propofol combined with nalbuphine group (group F).Patients in group F received nalbuphine 0.1 mg/kg intravenously 1 min before propofol administration, and patients in group P received same volume of normal saline.Propofol was infused by TCI and the initial target plasma concentration was set at 2μg/ml in all patients.The target concentration was adjusted gradually until the Ramsay sedation score reached 5.Then colonoscopy was started.During the colonoscopy, the propofol concentration was adjusted according to the Ramsay score.Ultrasound was used to monitor the movement of the right diaphragm of the patients.SpO2, MAP, HR, PETCO2, RR, diaphragmatic movement (DM), diaphragmatic thickness at the end of inspiration (TEI) and diaphragmatic thickness at the end of expiration (TEE) were recorded under calm breathing after entering the room (T0), Ramsay sedation score 5 points after propofol administration (T1), and Ramsay sedation score 2 after endoscopy (T2).The diaphragmatic thickening fraction (DTF) was calculated:DTF= (TEI-TEE) /TEI.Adverse reactions such as bradycardia, hypotension, body movement, and respiratory depression were recorded.Results Compared with T0, MAP, SpO2, HR and RR decreased, and PETCO2 increased at T1 time point in patients of the two groups (P<0.05).Compared with group F, the dose of propofol increased in group P (P<0.05).DM at T1 and T2, DTF at T1 were obviously higher in group F than those in group P (P<0.05).There were two cases had body movement in group P, and one case had bradycardia in group F.There was no case suffered from hypotension, respiratory depression and reflux aspiration in two groups.Conclusion Compared with propofol alone, propofol combined with nalbuphine can attenuate the dysfunction of the diaphragm.
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Objective To evaluate the optimum compatibility of nalbufine combined with ropivacaine for patient-controlled epidural analgesia (PCEA) after cesarean section.Methods A total of 100 parturients who were at full term with a singleton fetus,aged 24-35 yr,with body mass index of 29-33 kg/m2,of American society of Anesthesiologists physical status Ⅱ,scheduled for elective cesarean section under combined spinal-epidural anesthesia,were divided into 4 groups (n =25 each) using a random number table method:sufentanil 0.5 μg/ml plus 0.15％ ropivacaine group (SR group),nalbufine at final concentration of 0.2 mg/ml plus 0.15％ ropivacaine group (N1 R group),nalbufine at final concentration of 0.4 mg/ml plus 0.15％ ropivacaine group (N2R group) and nalbufine at final concentration of 0.4 mg/ml plus 0.1％ ropivacaine group (N3Rgroup).PCEA solution was prepared correspondingly after surgery,and all the drugs were diluted to 100 ml in normal saline in each group.The PCA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Visual analog scale scores of incisional pain and anduterine contraction pain were maintained＜4.Ramsay sedation scores were recorded at 8,12,24 and 48 h after surgery.The total pressing times of PCEA were recorded within 48 h after surgery.The development of adverse reactions such as nausea,vomiting,skin itching,numbness of lower extremity,urinary retention and respiratory depression was recorded in the analgesia period.Venous blood samples were collected before surgery and at 24 and 48 h after surgery for determination of plasma prolactin concentrations,and the time of colostrum was recorded.Neonatal nerve and adaptive capacity was assessed and scored.Results Compared with group SR,the total pressing times of PCEA were significantly reduced in N2R and N3R groups (P＜0.05),and no significant change was found in the total pressing times of PCEA in group N1R (P＞0.05).Compared with group N1R,the total pressing times of PCEA were significantly reduced in N2R and N3 R groups (P＜0.05).There was no significant difference in the total pressing times of PCEA between group N2R and group N3R (P＞0.05).The Ramsay sedation score was 2 in four groups.There was no significant difference in numbness of lower extremity,plasma prolactin concentrations or neonatal nerve and adaptive capacity scores among four groups (P＞0.05).Conclusion Nalbufine at final concentraction of 0.4 mg/ml mixed with 0.1％ ropivacaine is the optimum compatibility when used for PCEA after cesarean section.
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Objective To evaluate the optimum compatibility of nabufine mixed with flurbiprofen for patient-controlled intravenous analgesia (PCIA) after gynecological laparoscopic surgery.Methods A total of 210 patients,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologist physical status Ⅰ or Ⅱ,scheduled for gynecological laparoscopic surgery under general anesthesia,were divided into 4 groups using a random number table method:sufentanil 2.0 μg/kg+flurbiprofen axetil 2.0 mg/kg group (SF group,n =55),nalbuphine 1.5 mg/kg+flurbiprofen axetil 2.0 mg/kg group (N1 F group,n=49),nalbuphine 2.0 mg/kg+flurbiprofen axetil 2.0 mg/kg group (N2F group,n =55) and nalbuphine 3.0 mg/kg +flurbiprofen axetil 2.0 mg/kg group (N3F group,n=51).PCIA solution was prepared correspondingly after surgery in each group.The PCA pump was set up to deliver a 1 ml bolus dose with a 15-min lockout interval and background infusion at 2.0 ml/h.Nalbuphine 5 mg or sufentanil 5 μg was intravenously injected as a rescue analgesic to maintain visual analogue scale score at rest ＜4 at 48 h after surgery in SF and N1 F-N3F groups.Ramsay sedation scores were recorded on admission to post-anesthesia care unit (T1),at the time of post-anesthesia care unit discharge (T2) and at 6,24 and 48 h after surgery (T3-5).The total pressing times of PCIA in 0-6 h,6-24 h and 24-48 h periods after surgery and requirement for rescue analgesics were recorded.The incidence of adverse reactions such as nausea and vomiting,drowsiness and shivering within 48 h after surgery was also recorded.Results Compared with group SF,the incidence of nausea and vomiting was significantly decreased in N1 F and N2F groups,the requirement for rescue analgesics was significantly decreased,and the total pressing times of PCIA was reduced in N2F and N3 F groups,and Ramsay sedation scores at T3,4 were significantly increased in group N3F (P＜0.05).Compared with group N1 F,the requirement for rescue analgesics was significantly decreased,and the total pressing times of PCIA was reduced in N2F and N3F groups,and the incidence of nausea and vomiting and Ramsay sedation scores at T3,4 were significantly increased in group N3F (P＜0.05).Compared with group N2F,the incidence of nausea and vomiting was significantly increased (P＜ 0.05),and no significant change was found in the requirement for rescue analgesics,total pressing times of PCIA or Ramsay sedation scores in group N3F (P＞0.05).Conclusion Nabufine 2.0 mg/kg mixed with flurbiprofen 2.0 mg/kg is the optimum compatibility when used for PCIA after gynecological laparoscopic surgery.
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Objective To observe the effect of different dosage combinations of nalbuphine and sufentanil on postoperative analgesia in patients undergoing abdominal hysterectomy surgeries. Methods One hundred and twenty-five patients scheduled for selective abdominal hysterectomy surgeries in Affiliated Huaian Hospital of Xuzhou Medical University from January 2015 to January 2018 were randomly divided into sufentanil 100 μg group (group S), sufentanil 75 μg combined with nalbuphine 25 mg group (group NS1), sufentanil 50 μg combined with nalbuphine 50 mg group (group NS2), sufentanil 25 μg combined with nalbuphine 75 mg group (group NS2) and nalbuphine 100 mg group (group N). The analgesic pump was set in the five groups as follows: loading dose 3 ml, continuous dose 2 ml/h, bolus dose 0.5 ml, lockout time 15 min, total volume 100 ml. The scores of incision pain and visceral pain of 4, 8, 12, 24 and 36 h of NRS, Ramasy sedation score, number of analgesia pump compressions and incidence of adverse reactions were recorded respectively in patients after operation. Results Compared with those in group NS3 and group N,the scores of incision pain of NRS were significantly lower 4 and 8 h after surgery in group S, group NS1 and group NS2 (P < 0.05). Compared with those in group S and group NS1, the scores of visceral pain of NRS was significantly lower at the time 4 and 8 h after surgery in group NS2, group NS3 and group N (P<0.05). Compared with group NS2, the number of analgesia pump compression was significantly higher in group S, group NS1, group NS3 and group N, (3.0 ± 1.7), (3.0 ± 1.5), (2.9 ± 1.8), (2.9 ± 1.6) times vs. (1.7 ± 1.0) times, P<0.05. Compared with those in group S, the nausea and vomiting were lower in group NS2,group NS3 and group N, nausea: 8%(2/25), 8%(2/25), 4% (1/25) vs. 20% (5/25), vomiting: 8% (2/25), 8% (2/25), 8% (2/25) vs. 20% (5/25), P < 0.05. Conclusions The optimal ratio of nalbuphine to sufentanil in postoperative analgesia after abdominal hysterectomy surgeries was 1∶1, because it has good analgesic effect and low incidence of adverse reactions.