nalbuphine and Vomiting

The special antishivering action of meperidine may be mediated by its kappa or anticholinergic actions. We therefore tested the hypotheses that nalbuphine or atropine decreases the shivering threshold more than the vasoconstriction threshold. Eight volunteers were each evaluated on four separate study days: 1) control (no drug), 2) small-dose nalbuphine (0.2 microg/mL), 3) large-dose nalbuphine (0.4 microg/mL), and 4) atropine (1-mg bolus and 0.5 mg/h). Body temperature was increased until the patient sweated and then decreased until the patient shivered. Nalbuphine produced concentration-dependent decreases (mean +/- SD) in the sweating (-2.5 +/- 1.7 degrees C. microg(-1). mL; r(2) = 0.75 +/- 0.25), vasoconstriction (-2.6 +/- 1.7 degrees C. microg(-1). mL; r(2) = 0.75 +/- 0.25), and shivering (-2.8 +/- 1.7 degrees C. microg(-1). mL; r(2) = 0.79 +/- 0.23) thresholds. Atropine significantly increased the thresholds for sweating (1.0 degrees C +/- 0.4 degrees C), vasoconstriction (0.9 degrees C +/- 0.3 degrees C), and shivering (0.7 degrees C +/- 0.3 degrees C). Nalbuphine reduced the vasoconstriction and shivering thresholds comparably. This differs markedly from meperidine, which impairs shivering twice as much as vasoconstriction. Atropine increased all thresholds and would thus be expected to facilitate shivering. Our results thus fail to support the theory that activation of kappa-opioid or central anticholinergic receptors contribute to meperidine's special antishivering action.

Topics: Adult; Analgesics, Opioid; Atropine; Body Temperature; Cold Temperature; Conscious Sedation; Dose-Response Relationship, Drug; Heart Rate; Humans; Injections, Intravenous; Male; Muscarinic Antagonists; Nalbuphine; Oxygen Consumption; Oxyhemoglobins; Pupil; Respiratory Mechanics; Shivering; Vomiting

The impact of hypnotic drugs on postoperative analgesia has not been evaluated. We compared the influence of the maintenance of anaesthesia with either propofol or isoflurane on postoperative pain.. Forty ASA 1-2 women, undergoing cosmetic abdominoplasty were randomized to receive either 6-12 mg.kg-1.hr-1 propofol i.v. (P, n = 20) or MAC 1-1.5 isoflurane inhalation (Iso, n = 20). The lungs were ventilated with N2O 60% and O2 40%, and 1 microgram.kg-1 fentanyl i.v. provided intraoperative analgesia. Before surgical closure, 2 g propacetamol i.v. were administered. Postoperative analgesia was provided after hourly assessment of pain (VAS 0-100 mm), with 10 mg nalbuphine i.v. if VAS > or = 50 mm, during the eight hours after surgery. Sedation score (awake 0 to unrousable 4) was also recorded. Analgesia satisfaction score (nil 0 to excellent 4) obtained from the patient on discharge.. Sedation scores were similar in both groups except in the first postoperative hour, when it was higher in the Iso group. The VAS at rest (15.4 +/- 18.6 vs 29.7 +/- 19.8 mm, P = 0.0001) and nalbuphine requirements (0.13 +/- 0.35 vs 0.70 +/- 0.80 doses, P = 0.004) were lower in the Iso group during the first six hours, although emesis was more frequent than in P (60 vs 25%; P = 0.03). The incidence of analgesia satisfaction score (> or = 3) was similar between the two groups (P: 95; Iso: 75%).. These results suggested that isoflurane anaesthesia provides better analgesia than propofol anaesthesia in the first six hours after abdominoplasty.

Topics: Abdomen; Acetaminophen; Adult; Analgesia; Analgesics; Analgesics, Opioid; Anesthetics, Inhalation; Anesthetics, Intravenous; Female; Fentanyl; Humans; Injections, Intravenous; Intraoperative Care; Isoflurane; Nalbuphine; Pain Measurement; Pain, Postoperative; Patient Satisfaction; Propofol; Vomiting

To measure the incidence of nausea and vomiting in outpatients in relation to selection of, or withholding of, intraoperative opioid.. Prospective, randomized, double-blind control trial.. University general hospital.. 200 unpremedicated ASA status 1 and 11 patients, 8 to 80 years old, undergoing general anesthesia for ambulatory surgery.. Patients were randomized to four groups, three of which received equipotent doses of different opioids intravenously (i.v.) during induction of anesthesia. Group 1 received nalbuphine 0.25 mg/kg, Group 2, alfentanil 20 ug/kg; Group 3, fentanyl 2 ug/kg; and Group 4, normal saline.. We evaluated (1) incidence and severity of nausea and vomiting in the postanesthesia care unit (PACU) and over the next 24 hours; (2) time to PACU discharge; (3) need for antiemetic therapy; and (4) need for analgesic rescue in the PACU. The incidences of nausea and vomiting were similar in all groups, as were time to discharge, antiemetic, and nonsteroidal antiinflammatory drug requirements. The highest incidences of nausea and vomiting occurred at 6 hours in all groups (23% and 9.5%, respectively). Group 1 required lower rescue doses of morphine in the PACU but this result may have been an artifact due to employing the mixed agonist-antagonist opioid, nalbuphine, in this group.. Opioid administration at the doses employed during induction of anesthesia does not promote postoperative nausea or vomiting, nor increase length of stay in the PACU.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alfentanil; Ambulatory Surgical Procedures; Analgesics, Opioid; Anesthesia, General; Child; Double-Blind Method; Female; Fentanyl; Humans; Intraoperative Complications; Male; Middle Aged; Nalbuphine; Nausea; Pain, Postoperative; Prospective Studies; Vomiting

Forty patients received either midazolam or midazolam with nalbuphine in a double-blind randomised study of sedation for upper gastrointestinal endoscopy. There were less retching, gagging and salivation in the combination group compared to midazolam alone. They were also more cooperative. These resulted in greater ease of insertion of the gastroscope. There was no significant difference in the degree of amnesia in both groups. A significant decrease in oxygen saturation was noted in both groups during the procedure. Monitoring with a pulse oximeter is recommended when sedation is administered during gastroscopy.

Topics: Adolescent; Adult; Aged; Conscious Sedation; Double-Blind Method; Female; Gagging; Gastroscopy; Humans; Infusions, Intravenous; Male; Memory; Midazolam; Middle Aged; Nalbuphine; Oxygen; Prospective Studies; Salivation; Vomiting

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

Two consecutive studies were undertaken to evaluate the effectiveness of acupuncture as an antiemetic used in addition to premedication with opioids in patients undergoing minor gynaecological operations. In the first study 25 of the 50 patients underwent acupuncture immediately after premedication with 100 mg meptazinol, the rest receiving the drug alone, and in the second 75 patients were allocated randomly to one of three groups: a group receiving 10 mg nalbuphine and acupuncture, a group receiving premedication and dummy acupuncture, and a group receiving premedication alone. Manual needling for five minutes at the P6 acupuncture point (Neiguan) resulted in a significant reduction in perioperative nausea and vomiting in the 50 patients who underwent acupuncture compared with the 75 patients who received no acupuncture. These findings cannot be explained, but it is recommended that the use of acupuncture as an antiemetic should be explored further.

Topics: Acupuncture Therapy; Adolescent; Adult; Clinical Trials as Topic; Female; Humans; Intraoperative Complications; Meptazinol; Middle Aged; Nalbuphine; Nausea; Preanesthetic Medication; Vomiting

A double-blind comparison of some analgesic and gastrointestinal effects of nalbuphine and pethidine was performed in 28 women undergoing laparoscopic sterilisation. The opioid was given as an initial loading dose prior to the induction of general anaesthesia and further doses were given on demand in the postoperative period to achieve and maintain adequate pain relief. Gastric emptying in the immediate postoperative period was also assessed in each patient by measuring the rate of absorption of orally administered paracetamol. Nalbuphine was equally effective as pethidine as a postoperative analgesic, but may have been a less effective supplement to anaesthesia in the doses used in this study. Gastric emptying was profoundly depressed in all patients irrespective of which analgesic was used.

Topics: Absorption; Acetaminophen; Adult; Animals; Double-Blind Method; Drug Evaluation; Female; Gastric Emptying; Humans; Meperidine; Morphinans; Nalbuphine; Pain, Postoperative; Random Allocation; Vomiting

This is a retrospective study covering the ten-year period 1984-1993. Single shot spinal morphine (ITM) is compared with PCA nalbuphine for postoperative pain relief in children having abdominal or thoracic procedures. The records of 52 patients meeting selection criteria were examined. Nursing and physician notations were reviewed for hourly pain assessments, evidence of associated complications, respiratory depression, nausea and or vomiting, pruritus, and urinary retention. ITM provided significantly better pain relief (2.2 h in pain) during the first 24 h postoperatively than PCA nalbuphine (9.2 h in pain). With the exception of urinary retention which was significantly more frequent following ITM (58.6%) compared to PCA nalbuphine (8.7%), narcotic related complications were not different between the two groups. No difference in duration of hospital stay or ICU stay could be demonstrated. We conclude that ITM provides better pain relief, without more serious complications, than PCA nalbuphine. We recommend it as a safe, effective technique to treat postoperative pain in children following thoracic or upper abdominal procedures.

Topics: Abdomen; Adolescent; Analgesia, Patient-Controlled; Analgesics, Opioid; Child; Child, Preschool; Critical Care; Female; Hospitalization; Humans; Injections, Spinal; Length of Stay; Male; Morphine; Nalbuphine; Nausea; Pain Measurement; Pain, Postoperative; Pruritus; Respiration; Retrospective Studies; Thoracic Surgery; Urinary Retention; Vomiting

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

A therapeutic regimen is described for sedative, analgesic, and anti-emetic effect in patients receiving intra-arterial carmustine (BCNU) for malignant gliomas. This regimen consists of nalbuphine, 30 mg, i.v., and droperidol, 2.5 mg, i.v., given immediately prior to intra-carotid BCNU infusion. Droperidol, 2.5 mg, i.v., is then administered on four hour intervals for sixteen hours post-procedure. This combination provided excellent effect in nine patients treated for twelve intra-carotid infusions. None of the nine patients experienced vomiting, one experienced mild nausea several hours post-infusion, and non complained of severe pain or discomfort. Thirteen additional patients received diazepam, 10 mg, P.O., prior to the intra-carotid BCNU infusion, with fentanyl, 100 mcg, i.v., and prochlorperazine, 10 mg, i.m. at the onset of infusion. All thirteen patients suffered from severe nausea, vomiting, and orbital pain. The nalbuphine/droperidol combination is thought to provide a superior alternative to the traditional narcotic/pheonothiazine/benzodiazepine combination for carotid BCNU infusion. This combination has theoretical advantages for the patient with intracranial mass lesions by providing analgesia and sedation with minimal potential for respiratory depression and carbon dioxide retention.

Topics: Adult; Aged; Brain Neoplasms; Carmustine; Carotid Arteries; Diazepam; Droperidol; Drug Therapy, Combination; Fentanyl; Glioma; Humans; Injections, Intra-Arterial; Middle Aged; Morphinans; Nalbuphine; Nausea; Prochlorperazine; Vomiting