nalbuphine and Postoperative-Complications

The use of intrathecal morphine may result in serious side effects in parturients undergoing cesarean delivery. Nalbuphine, is a mu receptor antagonist and a ĸappa receptor agonist. Combinations of opioid agonist and agonist antagonist can decrease the incidence of opioid related side effects. We aimed to investigate the effect of adding nalbuphine, to intrathecal morphine on postoperative nausea and vomiting and pruritus after a cesarean delivery.. Eighty parturient undergoing elective cesarean delivery under spinal anesthesia were randomized into two similar groups. Group 1: received 10 mg of 0.5% hyperbaric bupivacaine with 0.2 mg morphine. Group 2: received as a group 1 plus 0.5 mg nalbuphine, with total volume 2.5 mL in both groups. Measurements: Data on the severity of nausea and vomiting were collected using a numerical rating scale and visual analogue scale was used to quantify pruritus. Onset and duration of sensory blockade, Visual Analog Scale for pain, the first time to ask for rescue analgesia and total rescue analgesic consumption were recorded.. Nausea and vomiting and pruritus severity scores and number of patients developed nausea and vomiting and pruritus were significantly lower (P<0.001) in group 2. Onset and duration of sensory block, time to first request for rescue analgesia, Visual Analog Scale for pain and paracetamol consumption showed no statistically differences between both groups (P>0.05).. We concluded that the addition of nalbuphine to intrathecal bupivacaine plus morphine significantly reduced the incidence and severity of postoperative nausea and vomiting and pruritus without affecting analgesic potency.

Topics: Adult; Analgesics, Opioid; Anesthesia, Obstetrical; Anesthesia, Spinal; Anesthetics, Local; Bupivacaine; Cesarean Section; Double-Blind Method; Drug Combinations; Elective Surgical Procedures; Female; Humans; Morphine; Nalbuphine; Postoperative Complications; Postoperative Nausea and Vomiting; Pregnancy; Prospective Studies; Pruritus; Young Adult

Topics: Adult; Anesthesia, Epidural; Anesthesia, Spinal; Blood Glucose; Cesarean Section; Dexmedetomidine; Female; Humans; Insulin; Nalbuphine; Postoperative Complications; Pregnancy; Shivering; Time Factors; Treatment Outcome; Uterine Contraction; Visual Analog Scale

In this prospective, randomized, double-blinded study, we compared the prophylactic efficacy of nalbuphine and ondansetron for the prevention of intrathecal morphine-induced pruritus after cesarean delivery. Two-hundred-forty parturients were randomly allocated into four groups. The N-4 group, O-4 group, O-8 group, and placebo group received IV 4 mg of nalbuphine, 4 mg of ondansetron, 8 mg of ondansetron, and 4 mL of normal saline, respectively, immediately after the baby was delivered. In the postanesthesia care unit, we found that the severity of pruritus score in the four groups was significantly different (P < 0.001). The prophylactic success rate for pruritus of the N-4, O-4, O-8, and placebo groups was 20%, 13%, 12%, and 6%, respectively (P < 0.001). The pruritus score between N-4 and placebo and O-4 and placebo was significantly different (P < 0.001 and P = 0.006, respectively). Treatment for pruritus was requested by patients in 25%, 47%, 51%, and 72% of patients in the N-4, O-4, O-8, and placebo groups, respectively (P < 0.001). There were no differences among groups in nausea/vomiting score, pain score, sedation score, or shivering score at 4, 8, and 24 h after surgery. Nalbuphine and ondansetron are more effective than placebo for the prevention of intrathecal morphine-induced pruritus after cesarean delivery.. Nalbuphine and ondansetron are more effective than placebo for the prevention of intrathecal morphine-induced pruritus after cesarean delivery.

Topics: Adult; Analgesics, Opioid; Cesarean Section; Double-Blind Method; Female; Humans; Morphine; Nalbuphine; Narcotic Antagonists; Ondansetron; Pain, Postoperative; Postoperative Complications; Postoperative Nausea and Vomiting; Pregnancy; Pruritus; Serotonin Antagonists

In this prospective, randomized, double-blinded study, we compared the efficacy of nalbuphine and propofol for treating intrathecal morphine-induced pruritus after cesarean delivery. One-hundred-eighty-one parturients who developed moderate to severe pruritus after the administration of intrathecal morphine were randomly allocated into two groups. One group received 3 mg IV nalbuphine (n = 91), and the other received 20 mg IV propofol (n = 90). The improvement of pruritus and other adverse effects was determined at 10 min after study drug administration. The treatment success rate was higher in the Nalbuphine group than in the Propofol group (83% vs 61%; P < 0.001). Among the successfully treated patients, recurrence rates of moderate to severe pruritus within 4 h were not significantly different (nalbuphine 9% versus propofol 7%; P = 0.76). Other side effects, such as decreased analgesia, increased nausea, vomiting, increased sedation, pain on injection, and dizziness, were not significantly different between groups. Sedation and pain on injection, which were the two most common side effects, were minor and clinically inconsequential.. Nalbuphine was superior to propofol for the treatment of intrathecal morphine-induced pruritus after cesarean delivery.

Topics: Adult; Analgesics, Opioid; Cesarean Section; Double-Blind Method; Female; Humans; Injections, Spinal; Morphine; Nalbuphine; Postoperative Complications; Pregnancy; Prospective Studies; Pruritus

Opioids given as adjuncts to balanced inhalational anaesthesia augment postoperative nausea and vomiting (PONV). Tramadol, equipotent to pethidine, does not depress respiration, but can cause an increase in blood pressure and headache via its monoaminergic actions. Nalbuphine, ten times as potent as pethidine, has a ceiling respiratory depressant and ceiling analgesic effect at > 0.3 mg.kg-1. We compared the effects of equipotent doses of tramadol and nalbuphine (3.0 and 0.3 mg.kg-1, respectively) given as analgesic with induction of anaesthesia on emesis during recovery from anaesthesia and on PONV and headache until 24 h after ENT surgery, using saline (0.2 ml.kg-1) and an equipotent dose of pethidine (1.5 mg.kg-1) as controls.. The study population (N = 281) comprised 4 comparable subgroups (N = 69 to 71 each). Anaesthetic medications were standardised. Emesis during recovery from anaesthesia and nausea, vomiting, retching, headache and administrations of antiemetic and analgesics until 24 h after surgery were recorded.. Emesis and antiemetic requirements during recovery from anaesthesia were similar and infrequent in each group, as were the incidences of nausea alone (3 to 5%), vomiting alone (17 to 31%), and nausea with vomiting (10 to 22%) during the first 24 h after surgery. However, any complaint of PONV was least frequent in the saline and pethidine groups (32% and 37%, respectively) and most frequent in the tramadol and nalbuphine groups (49% and 52%, respectively; P < 0.05 versus saline, both comparisons; P = NS versus pethidine, both comparisons). The times to onset and severity of PONV were similar in each group, but patients given nalbuphine most frequently (P < 0.025) needed rescue antiemetic to treat PONV. Headache occurred with similar frequency in each group.. It is concluded that tramadol, nalbuphine and pethidine have similar emetic effect in the doses and manner used, and that tramadol does not increase the incidence of post-operative headache when used as peroperative analgesic.

Topics: Adolescent; Adult; Aged; Analgesics, Opioid; Anesthesia Recovery Period; Child; Child, Preschool; Female; Follow-Up Studies; Headache; Humans; Incidence; Male; Meperidine; Middle Aged; Nalbuphine; Otorhinolaryngologic Surgical Procedures; Placebos; Postoperative Complications; Postoperative Nausea and Vomiting; Premedication; Sodium Chloride; Tramadol

To search for the optimal dosage of nalbuphine relief of intrathecal-morphine induced pruritus after caesarean section.. Ninety parturients who developed moderate to severe pruritus caused by intrathecal morphine after caesarean section were randomly allocated into 3 groups receiving 2, 3 and 4 mg of intravenous nalbuphine respectively. The improvement of pruritus and adverse effects of nalbuphine such as increasing pain scores, nausea, vomiting, sedation and respiratory depression were evaluated at 15 minutes after nalbuphine administration.. Percentage of successful treatment of pruritus with 2, 3 and 4 mg, nalbuphine were 86.7, 96.7 and 100, respectively (p = 0.12). There was no statistically significant difference in adverse effects. No evidence of respiratory depression was detected. However, there was significant increase in pain scores in group of 4 mg nalbuphine (p = 0.004).. Nalbuphine of 2 to 3 mg was considered to be adequate in treatment of intrathecal morphine induced pruritus after caesarean section without increasing pain scores or causing other side effects.

Topics: Adult; Anesthesia, Obstetrical; Antipruritics; Cesarean Section; Dose-Response Relationship, Drug; Double-Blind Method; Female; Humans; Morphine; Nalbuphine; Narcotic Antagonists; Postoperative Complications; Pregnancy; Prospective Studies; Pruritus; Treatment Outcome

To compare both the efficacy and cost of nalbuphine and diphenhydramine in the treatment of intrathecal morphine-induced pruritus following Caesarean section.. Eighty patients, undergoing elective Caesarean section under spinal anaesthesia, were randomized, in a prospective, double-blind trial, to receive either nalbuphine (Group NAL) or diphenhydramine (Group DIP) for the treatment of SAB morphine-induced pruritus. All patients received an intrathecal injection of 10-12 mg hyperbaric bupivacaine 0.75% and 200 micrograms preservative free morphine. Postoperative pruritus was assessed, using a visual analogue scale (VAS), for 24 hr. Pruritus treatment was administered upon patient request and by a nurse blinded to the treatment given. Patients who failed to respond to three doses of the study drug were deemed treatment failures. Patient satisfaction was assessed with a questionnaire given 24 to 48 hr after surgery. Direct drug costs were calculated based on the pharmacy provision costs as of April 1996.. Eighty patients were enrolled and 45 requested treatment for pruritus. Patients treated with NAL (n = 24) were more likely to achieve a VAS score of zero with treatment (83% vs 43%, P < 0.01), had a higher delta VAS following treatment (4 +/- 2 vs 2 +/- 2, P < 0.003), and experienced fewer treatment failures (4% vs 29%, P < 0.04), than those treated with DIP (n = 21). Group NAL patients were also more likely to rate their pruritus treatment as being good to excellent (96% vs 57%, P < 0.004). Direct drug costs were higher for NAL than for DIP ($6.4 +/- 3.1 vs $1.7 +/- 0.7, respectively, P < 0.0001).. Nalbuphine is more effective than diphenhydramine in relieving pruritus caused by intrathecal morphine and the cost differences are small.

Topics: Adult; Analgesics, Opioid; Antipruritics; Cesarean Section; Diphenhydramine; Double-Blind Method; Female; Humans; Injections, Spinal; Morphine; Nalbuphine; Patient Satisfaction; Postoperative Complications; Pregnancy; Prospective Studies; Pruritus

Opioids may depress respiration and contribute to airway obstruction after adenotonsillectomy for obstructive sleep disorder. We compared the respiratory and analgesic effects of nalbuphine, which has a ceiling effect for respiratory depression, and pethidine in 90 children (aged 2-12 years) with a history of obstructive sleep disorder undergoing adenotonsillectomy. Children were scored for their obstructive sleep disorder history and were randomly allocated to receive intravenously at induction of anaesthesia either nalbuphine 0.1 mg.kg-1 (group N) or pethidine 1 mg.kg-1 (group P). End-tidal carbon dioxide was measured in the recovery period using a nasopharyngeal catheter and oxygen saturation whilst breathing air; pain and sedation scores were recorded for 6 h postoperatively. Both groups were similar with respect to the demographic data and respiratory measurements: mean (SD) oxygen saturation on air in the recovery area (96.2% (1.2) vs. 96.5% (1.1) in group N and P, respectively) and mean (SD) end-tidal carbon dioxide (46.4 (5.5) mmHg vs. 47.7 (4) mmHg in group N and P, respectively). High obstructive sleep disorder score, history of apnoea, hyperactivity and loud snoring were found to be the best predictors of early postoperative oxygen desaturation in both groups.

Topics: Adenoidectomy; Analgesics, Opioid; Carbon Dioxide; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Hypoxia; Male; Meperidine; Nalbuphine; Oxygen; Pain, Postoperative; Postoperative Complications; Respiration; Risk Factors; Sleep Apnea Syndromes; Tonsillectomy

Nalbuphine (0.3 mg.kg-1) and buprenorphine (2.5 micrograms.kg-1) were compared as part of a total intravenous anaesthesia regimen using a propofol infusion in 60 patients undergoing laparoscopic cholecystectomy in a randomised double-blind study. Changes in haemodynamic variables greater than 20% from the baseline were noted. No difference was observed in blood pressure but the heart rate was significantly lower in the buprenorphine group. Intra-operative bradycardia (heart rate < 60 beat.min-1) occurred more often in the buprenorphine group. Recovery was fast and comparable with both drugs and no patient reported awareness. Quality of analgesia was similar in both groups. Both drugs provide suitable analgesic supplementation to total intravenous anaesthesia.

Topics: Adult; Analgesics, Opioid; Anesthesia, Intravenous; Bradycardia; Buprenorphine; Cholecystectomy, Laparoscopic; Double-Blind Method; Drug Administration Schedule; Hemodynamics; Humans; Middle Aged; Nalbuphine; Pain, Postoperative; Patient Satisfaction; Postoperative Complications

Postoperative shivering is common and has potentially adverse side effects in high-risk patients. Meperidine, which binds to both mu- and kappa-opioid receptors, is reported to be more effective in treating shivering than morphine or fentanyl. Recent data indicate that much of meperidine's special antishivering effect may be mediated by its kappa-opioid receptor activity. Nalbuphine, an opioid agonist/antagonist also has a potent affinity for kappa-receptors. The aim of this study was to evaluate the antishivering effect of nalbuphine in comparison to meperidine.. 100 ASA physical status I-II patients shivering after elective surgery were included in the study. General anaesthesia was performed with thiopentone, low-dose fentanyl and enflurane in N2O/O2. After arrival in the recovery room patients shivering within 5 min received either meperidine 25 mg or nalbupine 10 mg in a double-blind, randomised manner. The duration and severity of shivering, heart rate, respiratory rate, blood pressure, end-tidal CO2 concentration, O2-saturation and awareness were documented until 20 min after injection. Patients in need of a second injection were excluded from the study.. Demographic variables, duration of operation and temperature decreases were not significantly different between treatment groups. The suppression of shivering was achieved within 4.0 +/- 3.5 or 4.6 +/- 4.1 min following the injection of meperidine or nalbuphine, respectively (p = NS). Vital signs and postoperative vigilance showed no significant differences. No adverse side effects were observed.. The data indicated that nalbuphine suppressed postoperative shivering as effectively and timely as meperidine in equianalgesic doses. The observation is consistent with the hypothesis that stimulation of kappa-opioid receptors is a likely explanation for much of meperidine's antishivering action.

Topics: Adult; Blood Pressure; Body Temperature Regulation; Carbon Dioxide; Double-Blind Method; Female; Heart Rate; Humans; Male; Meperidine; Middle Aged; Nalbuphine; Oxygen; Postoperative Complications; Receptors, Opioid, kappa; Shivering

In a randomized double-blind placebo-controlled trial involving 80 patients nalbuphine 10 mg and 20 mg were compared with pethidine 100 mg and a placebo given i.m. at least 90 min before minor gynaecological surgery. Nalbuphine proved a suitable alternative to pethidine, producing beneficial sedation which was maximum at 60 min after injection. Both nalbuphine and pethidine reduced the excitatory sequelae of methohexitone induction. Increasing the dose of nalbuphine from 10 mg to 20 mg produced no significant additional sedation or intraoperative benefit. Short-lived pain at the injection site was a feature of the use of nalbuphine in either dose. The main disadvantage of nalbuphine was nausea and vomiting of delayed onset, the frequency of which was similar after either dose.

Topics: Adult; Clinical Trials as Topic; Female; Humans; Meperidine; Morphinans; Nalbuphine; Nausea; Postoperative Complications; Preanesthetic Medication; Vomiting

To assess the safety of conscious sedation in patients undergoing endoscopic retrograde cholangio pancreaticography (ERCP).. An observational study.. Department of Gastroenterology, Liaquat National Hospital, Karachi, from April 2010 to April 2015.. All patients underwent ERCP procedure under midazolam and/or nalbuphine were included. Safety was assessed by monitoring the hemodynamics and complications during procedure till discharge from hospital. SPSS version 20 was used for descriptive analysis.. A total of 550 procedures were enrolled for the study. The mean age of the patients was 50.85 ±15.66 years. There were 197 (35.8%) males. Out of 550 procedures, only 2 (0.4%) reported complications. The study reports a success rate of 531 (96.5%) procedures who underwent ERCP with conscious sedation. Only 19 (3.5%) cases could not be completed successfully under conscious sedation and were converted to general aneasthesia.. The present study shows that ERCP technique is safe under conscious sedation as it delivers balanced tranquillity.

Topics: Adult; Aged; Analgesics, Opioid; Cholangiopancreatography, Endoscopic Retrograde; Conscious Sedation; Female; Humans; Hypnotics and Sedatives; Intraoperative Complications; Male; Midazolam; Middle Aged; Nalbuphine; Postoperative Complications

Herniorraphy is a common surgical intervention in infants, particularly in those born prematurely. Prematurity and perioperative sedation have been shown to be risk factors for postoperative apnea. However, their influence upon PACU stay duration has not been evaluated. The goal of this study was to investigate predictive factors for PACU stay in infants undergoing herniorraphy.. This study is a retrospective analysis of perioperative data in infants <6 months of age undergoing herniorraphy during the period November 2007-November 2009. Collected data included age, gestational age at birth, post-conceptional age, weight, weight at birth, type of anesthesia (spinal vs general), perioperative administration of opioids and paracetamol, duration of surgery, duration of PACU stay, and apnea in PACU. Data analysis used classification and regression trees (CART) with a 10-fold cross-validation.. Two hundred and ninety-six patients were included in the analysis. Five parameters were found to predict the duration of PACU stay: a post-conceptional age below 45 weeks, prematurity, general anesthesia, postoperative opioid administration, and the use of intraoperative regional analgesia. CRT method allows constructing a decision tree with eight terminal nodes. The percentage of explained variability of the model and the cross-validation were 79.7% and 76.6%, respectively.. Our study allows construction of an accurate predictive tree for PACU stay during herniorraphy in infants <6 months. Parameters found to influence the duration of PACU stay were related to anesthesia techniques and perinatal outcomes.

Topics: Analgesics; Anesthesia, General; Anesthesia, Spinal; Apnea; Birth Weight; Cohort Studies; Conscious Sedation; Critical Care; Databases, Factual; Decision Trees; Female; Gestational Age; Herniorrhaphy; Humans; Infant; Infant, Newborn; Infant, Premature; Length of Stay; Male; Monitoring, Physiologic; Nalbuphine; Narcotics; Postoperative Complications; Predictive Value of Tests; Regression Analysis; Retrospective Studies

To take advantage of the laparoscopic procedure, a new minimally invasive technique of appendectomy for nonobese and uncomplicated appendicitis is presented. Initially, diagnostic laparoscopy is performed through a minimal skin incision (microceliotomy) 1.5-2.0 cm in length in the right lower abdomen to rule out other disease. Then an appendectomy is performed using conventional surgical instruments under direct vision through the previous skin incision. There were 18 women and 12 men in this series. The mean age was 22.6 years. Pathologic findings of the appendix were: 2 normal, 13 catarrhal, 10 suppurative, and 5 gangrenous type. The mean operation time was 30.7 min. The mean frequency of postoperative analgesic requirement (nalbuphine 0.2 mg/kg) was 0.9 times. The mean hospital stay was 4.1 days (range, 2-7 days), and the duration until return to full activity was 7.6 days (range, 5-14 days). There was no mortality or morbidity. This appendectomy technique is a useful method for minimizing the postoperative pain and operative scar, thus allowing the patient an early return to full activity.

Topics: Activities of Daily Living; Adolescent; Adult; Analgesics, Opioid; Appendectomy; Appendicitis; Child; Cicatrix; Female; Gangrene; Humans; Laparoscopes; Laparoscopy; Length of Stay; Male; Microsurgery; Middle Aged; Minimally Invasive Surgical Procedures; Nalbuphine; Pain, Postoperative; Postoperative Complications; Suppuration; Time Factors

The incidence of postoperative illness was monitored for 6 hours in 74 women premedicated with nalbuphine, 10 mg, and undergoing short gynecologic operations of similar duration under methohexitalnitrous oxide-oxygen anesthesia. Each patient received P6 acupuncture for 5 minutes at the time of administration of premedication. In random order the site of the acupuncture had been previously infiltrated with normal saline solution in half of the patients and 1% lidocaine in the remaining patients. Postoperative emetic sequelae occurred significantly more often in those who received lidocaine compared with the group that received saline solution. This demonstrates the ability of a local anesthetic administered at the point of stimulation to block the antiemetic action of P6 acupuncture in a manner similar to that shown by others for analgesia.

Topics: Acupuncture Analgesia; Adult; Anesthesia, Local; Female; Humans; Lidocaine; Nalbuphine; Postoperative Complications; Preanesthetic Medication; Random Allocation; Vomiting

Topics: Adult; Female; Heart Rate; Humans; Infant, Newborn; Male; Middle Aged; Morphinans; Morphine; Nalbuphine; Nausea; Pain; Postoperative Complications; Respiration

Topics: Humans; Morphinans; Nalbuphine; Postoperative Complications; Respiratory Insufficiency; Time Factors

Topics: Adult; Aged; Female; Humans; Male; Morphinans; Nalbuphine; Postoperative Complications; Respiratory Insufficiency; Time Factors

Topics: Aged; Female; Heroin; Humans; Morphinans; Nalbuphine; Postoperative Complications; Respiratory Insufficiency; Time Factors