nalbuphine and Wounds-and-Injuries

This study aimed to determine which of two paramedic administered nalbuphine dosing regimens combined the greater analgesic effect with the minimum of adverse events.. Patients suffering from chest pain or trauma were randomised to receive either a rapid dosing regimen (10 mg over 30 seconds, repeated once after three minutes if pain score remained above three) or a cautious regimen (5 mg over two minutes, repeated at three minute intervals if pain score remained above three to a maximum dose of 20 mg). Data were collected on analgesic effectiveness, changes in vital signs, and patient reported side effects.. The pain score fell by a mean of 4.29 and 3.49 in the rapid and cautious regimen groups respectively (difference = 0.79, 95% CI 0.09 to 1.5, p = 0.028). However, over half the patients in both groups continued to suffer significant pain on arrival at hospital. There were no significant changes in vital signs after nalbuphine, but there was a greater incidence of patient reported drowsiness in rapid regimen patients (42% compared with 21%, 95% CI = 6.96 to 34.12%, p = 0.003).. A rapid dosing regimen of nalbuphine using 10 mg increments is more effective than and equally as safe as a cautious regimen using 5 mg increments. Further research is required to determine if a maximum dose exceeding 20 mg would result in fewer patients continuing to suffer significant pain before arrival at hospital.

Topics: Adult; Aged; Analgesia; Analgesics, Opioid; Chest Pain; Dose-Response Relationship, Drug; Drug Administration Schedule; Emergency Medical Services; Female; Humans; Male; Middle Aged; Nalbuphine; Pain Measurement; Wounds and Injuries

In a previous study concerning balanced anesthesia we realized that the adrenergic sympathetic reaction caused by intubation could not be suppressed by nalbuphine-HCl (NAL), a new narcotic agonist-antagonist in the same way as by fentanyl (FE). The aim of the study was to investigate whether the observed autonomic reaction could be overcome by: (a) varying the interval between injection of NAL and intubation or (b) increasing the induction-dose of NAL. MATERIALS and METHODS. After receiving institutional approval and the patients' written informed consent, a two-part randomized trial arrangement was made using two groups of 10 surgical patients each. During the first part the induction-dose of NAL was 1.5 mg/kg BW and that of FE was 0.005 mg/kg BW. Midazolam 0.15 mg/kg BW was the induction hypnotic. Orotracheal intubation was performed 15 min after NAL and 10 min after FE injection. During the second part, the NAL dosage was 2.5 mg/kg BW and intubation was carried out 10 min after opiate injection. Induction conditions in the FE group were unchanged. RESULTS. NAL causes adrenergic sympathetic hemodynamic and autonomic reactions immediately after injection (Figs. 1a + b, 2a + b). The rate-pressure product increase during intubation is significantly higher after NAL than after FE administration and cannot be suppressed by increasing the dosage or increasing the injection-intubation interval. In contrast, the postoperative period is characterized by long-lasting analgesia (114 min vs 82 min in the FE group) and sedation, especially after administration of 2.5 mg/kg BW NAL. CONCLUSION. These results may be explained by the agonist-antagonist activity of NAL at the opiate receptor sites.

Topics: Adult; Anesthesia, General; Anesthesia, Inhalation; Anesthesia, Intravenous; Blood Pressure; Clinical Trials as Topic; Dose-Response Relationship, Drug; Female; Fentanyl; Heart Rate; Humans; Male; Morphinans; Nalbuphine; Random Allocation; Respiration; Wounds and Injuries

Pain is one of the major symptoms complained about by patients in the prehospital setting, especially in the case of trauma. When there is mountainous topography, as in Switzerland, there may be a time delay between injury and arrival of professional rescuers, in particular on ski slopes. Administration of a safe opioid by first responders may improve overall treatment. We therefore assessed administration of nasal nalbuphine as an analgesic treatment for trauma patients in Switzerland.. This observational cohort study examined 267 patients who were treated with nasal nalbuphine by first responders in six ski resorts in Switzerland. All first responders were instructed to begin treatment by assessing the feasibility of using nalbuphine to treat pain in the patient. A treatment algorithm was developed and distributed to assure that nalbuphine was only administered following a strict protocol. Data regarding pain scores and pain reduction after administration of nalbuphine were collected on-site. Refills were handed out to the first responders with the return of each completed questionnaire.. Nalbuphine provided effective pain relief, with the median level of pain on the numeric rating scale for pain reduced by 3 units on average, from 8 points (p < 0.001). The multivariate regression model showed that pain reduction was more pronounced in patients with higher initial pain levels. Nalbuphine was more effective in adolsecents than in patients aged 20 to 60 years (p = 0.006). No major side effects were observed.. Nasal administration of nalbuphine by first responders is a presumably safe and effective noninvasive pain management strategy for acutely injured patients in the prehospital setting. This may be an alternative, especially in the case of severe pain and prolonged time between arrival of the first responders and arrival of EMS/HEMS personnel on scene.

Topics: Aged; Analgesics, Opioid; Cohort Studies; Emergency Medical Services; Emergency Responders; Female; Humans; Male; Middle Aged; Nalbuphine; Pain; Prospective Studies; Skiing; Switzerland; Wounds and Injuries

Paramedic training and skills have been introduced in the United Kingdom in an attempt to improve prehospital patient care. There is presently little control and quality assurance in this potentially difficult environment and paramedic protocols have not been validated. We studied the use of nalbuphine by paramedics for patients with major injury in West Yorkshire. A case-control study was carried out using two cohorts of patients from the regional Major Trauma Outcome Study (MTOS) database; one group had received prehospital nalbuphine by paramedics (the intervention) and a matched group who had not (the control). Both groups of patients were reviewed by a panel of three consultants and a paramedic to assess which patients received or could have received nalbuphine appropriately. Only 85 patients from a database of 4170 patients received nalbuphine. Fifty-two (61%) patients were thought by the panel to have been given nalbuphine appropriately. The panel also concluded that 21 (18%) of the 115 patient control group could have been administered nalbuphine but did not receive the drug. This study demonstrates inadequate and sometimes inappropriate use of nalbuphine in prehospital trauma care. Quality assurance and audit systems should be implemented to identify and correct these deficiencies.

Topics: Adolescent; Adult; Aged; Analgesics, Opioid; Drug Utilization; Emergency Medical Services; Emergency Medical Technicians; Glasgow Coma Scale; Hemodynamics; Humans; Injury Severity Score; Middle Aged; Nalbuphine; Pain; Quality Control; Retrospective Studies; Wounds and Injuries

Topics: Adolescent; Adult; Aged; Anesthesia Recovery Period; Anesthesia, General; Child; Child, Preschool; Depression, Chemical; Digestive System Diseases; Fentanyl; Heart Diseases; Humans; Middle Aged; Nalbuphine; Naloxone; Postoperative Care; Respiratory Insufficiency; Wounds and Injuries

Forty-six patients with moderate to severe pain caused by orthopedic injuries, burns, multiple trauma, or intraabdominal conditions were treated with intravenous (IV) nalbuphine hydrochloride (Nubain; DuPont Pharmaceuticals, Wilmington, DE) by paramedics before arrival at the hospital. Patients who weighed less than 60 kg received 15 mg nalbuphine, and patients weighing greater than 60 kg received 20 mg nalbuphine. Forty-one of 46 patients (89%) experienced pain relief from nalbuphine, with maximum relief occurring within 15 minutes after the administration of the drug. Two addicted patients received no pain relief. There were no untoward side effects following nalbuphine administration, and the patients' heart rates, mean arterial pressures, and respiratory rates remained constant and stable throughout the study period. Repeated assessment of the patient by paramedics in the field was not impaired by nalbuphine treatment. In summary, nalbuphine hydrochloride is a useful and safe analgesic drug for IV use by paramedics in the prehospital setting.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Emergencies; Emergency Medical Technicians; Female; Humans; Male; Middle Aged; Morphinans; Nalbuphine; Pain; Wounds and Injuries