Download full-text PDF. Medical Studies/Studia Medyczne ; 33/2. Review paper. Nalbuphine: some aspects of the research and. PDF | Background and Aim Nalbuphine as an adjuvant intrathecally can produce significant analgesia with minimal Download full-text PDF. NUBAIN (nalbuphine hydrochloride) is a synthetic opioid agonist-antagonist NUBAIN is available in two concentrations, 10 mg and 20 mg of nalbuphine.
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The introduction of nalbuphine to intravenous sedation with midazolam added little to There was a greater tendency for patients who received nalbuphine and . to Evaluate the Effects of Intrathecal Nalbuphine in Patients of Lower Abdominal Surgeries under. Spinal Anaesthesia. Pallavi Ahluwalia1, Amit Ahluwalia2. The agonist/antagonist analgesics, butorphanol (Stadol) and nalbuphine (Nubain ), are being increasingly employed as intravenous sedation agents;.
The methods were carried out in accordance with the approved guidelines. We confined the search for full reports of randomized controlled trials.
There were no language restrictions. We got hits in the Cochrane Library, and hits for PubMed. We also reviewed citations listed in retrieved articles to identify additional studies. Study Selection RCTs were eligible for analysis if the following criteria was met: 1 all patients should be randomly divided into nalbuphine and morphine groups; 2 Studies should evaluate efficacy and safety of nalbuphine compared with morphine; RCTs were eligible if they included at least one group receiving nalbuphine and one group receiving morphine.
Two reviewers independently searched literature with the same retrieval strategy, assessed retrieved titles and abstracts, and downloaded potentially relevant articles for further assessment. Disagreements on data extraction were resolved through discussion. Quality assessment Study quality was judged by the Jadad scale score 5 points according to the criteria proposed by Jadad and colleagues 21 , which evaluates studies based on randomization, blinding and dropouts.
A study with a Jadad score between 3 and 5 was considered a high quality study Sensitivity analyse and subgroup analysis could be conducted. Meta regression analysis by the stata statistical software version Tau-squared expresses remel estimate of between-study variance, and the smaller the value is, the better the goodness of fit of the model becomes. R-squared represents how much the covariate currently into the model can explain the amount of variation between the research.
All P values reported are two-sided. Discussion Overall, patients were included in the meta-analysis. This meta-analysis of randomized controlled trials provides the solid evidence to date regarding the efficacy and safety comparing nalbuphine with morphine.
We discovered nalbuphine was comparable to morphine regarding analgesic efficacy. As we know, the evaluation of incidence of pain relief we extracted was not the most direct evidence, which was weakly expressed in clinical evidence for clinical effects, and thus, could not do better than the direct evidence of pain scores for evaluation. Even so, the outcomes we provided were worth considering.
The prolonged duration of analgesia observed in our study after epidural nalbuphine and lidocaine—nalbuphine when compared with lidocaine alone is congruent with previously reported results of other opioids in humans and dogs [22,23]. The shorter duration of analgesia produced by epidural lidocaine or lidocaine—nalbuphine, when compared with nalbuphine alone, may be attributed to vasodilatation and increased absorption of the drug from the spinal cord into systemic blood circulation as a result of sympathetic blockade produced by lidocaine .
The rapid onset of Fig.
Analgesia scoring of lidocaine, nalbuphine, and lidocaine—nalbuphine groups over the study duration. The intense analgesia achieved with lidocaine—nalbuphine combination in comparison with either lidocaine or nalbuphine alone could be attributed to the synergy of antinociceptive effects of lidocaine and nalbuphine as both of them act through separate analgesic mechanisms [9,10]. Nalbuphine increases inhibition of synaptic pain-impulse transmission by inhibiting the release of substance P from the primary afferent neurons and on postsynaptic opioid receptors to hyperpolarize the transmission cells.
Lidocaine acts primarily by inhibition of action potentials via sodium channel blockade  as well as by reduction of axonal and synaptic excitation of pain neurons through effects on substance P and calcium channels. Drugs working through separate analgesic mechanism have supraadditive or synergistic analgesic effects . The mild ataxia reported after administration of lidocaine and lidocaine—nalbuphine injections, and its absence in nalbuphine group, could be attributed to the sensory and motor block produced by lidocaine .
None of the donkeys in the present study showed severe ataxia or falling, and this could be attributed to the low volume of the treatments used. Mild sedation produced by epidural nalbuphine and lidocaine—nalbuphine combination, and its absence in lidocaine group, may be a result of the absorption of nalbuphine into the blood stream. The heart rate did not change after epidural lidocaine as shown in Table 1. Heart rate was only increased in nalbuphine and lidocaine—nalbuphine combination.
Other reports of increased heart rate with lidocaine epidural analgesia have been reported [20,28]; this increase was attributed to the sympathetic nerve block and vasodilatation induced by lidocaine . Similar increase in heat rate was reported after epidural injection of other opioids tramadol , and this increase was explained as tramadol may cause serotonin syndrome leading to increased heart rate and blood pressure .
The pharmacokinetics of intravenous, intramuscular, and subcutaneous nalbuphine in healthy subjects
The rectal temperature appeared to be unchanged throughout the course of epidural analgesia as indicated in Table 1. The main limitations of the present study are the use of relatively small number of donkeys in an experimental model, with only one injected total volume 5 mL.
Further studies should be directed toward using nalbuphine—lidocaine combination for epidural anesthesia in clinical practice in a large number of animals with different doses. In conclusion, nalbuphine alone produces analgesia of long duration but of slow onset.
The combination of lidocaine—nalbuphine administered epidurally in donkeys resulted in rapid onset 6. Epidural and spinal anesthesia and analgesia in the equine. Clin Tech Equine Pract ;— Epidural anesthesia in donkeys.
Vet Rec ;—2. The pharmacology of local anesthetics. Anaesthesia ; — Effects of epidural opioid analgesics on heart rate, arterial blood pressure, respiratory rate, body temperature, and behavior in horses.
Vet Ther ;— Alpha 2 -adrenergic agonists for regional anesthesia: a clinical review of clonidine Anesthesiology ;— Evaluation of the analgesic effects of epidurally administered morphine, alfentanil, butorphanol, tramadol, and UH in horses. Am J Vet Res ;— Comparison of analgesic effects of caudal epidural 0. J Equine Vet Sci ;—5.
Synergistic antinociceptive interaction after epidural coadministration of morphine and lidocaine in rats. Lobar analgesia with epidural bupivacaine plus fentanyl enhancement with epinephrine and inhibition with 2-chloroprocaine. Anesthesiology ;—8. Pharmacology of nalbuphine.
Epidural Lidocaine, Nalbuphine, and Lidocaine–Nalbuphine Combination in Donkeys
Ann Fr Anesth Reanim ;—8. Onset and offset of intrathecal morphine versus nalbuphine for postoperative pain relief after total hip replacement. Acta Anaesthesiol Scand ; —5.
A comparison of the analgesic and respiratory effects of epidural nalbuphine or morphine in postthoracotomy patients. Intrathecal administration of morphine was first described by Wang in a group of eight patients with genitourinary malignancies in , which was later followed up by various other studies. Since then, the use of intrathecal opioids has become a widely accepted technique for providing effective postoperative pain relief. Materials and Methods After obtaining approval from the institutional ethics committee and written informed consent from patients, adult American Society of Anaesthesiologists ASA physical status I and II patients age between 18 and 60 years scheduled for elective lower limb surgery were included in this prospective study.
Patients with a history of adverse response to ropivacaine or nalbuphine, pregnant patients, patients with comorbid diseases such as diabetes and hypertension, patients receiving phenothiazine, hypnotics or other central nervous system depressants or suffering from peripheral or central neurological, cardiac, respiratory, hepatic, renal disease or with body weight more than kg or less than 40 kg and patients having contraindication to SAB Sub arachnoid block were excluded from study.
The study drug was injected by an independent anaesthesiologist in a double-blind fashion who did not participate in observation or collection of data. Both the patient and the anaesthesiologist were blinded to the patient's group assignment and all recordings were performed by an anaesthesiologist, who was blinded to the randomisation schedule.
All the patients were asked to fast for at least 8 h before the procedure. Baseline vital parameters were recorded. Under all aseptic and antiseptic precautions, SAB was performed with 3.
Then, the patients were placed in the supine or lateral position for surgery. Advanced equipments and drugs for resuscitation, airway management and ventilation were kept ready, in anticipation of any untoward event. The segmental level of sensory block to pinprick was evaluated bilaterally along the mid-axillary line using a short beveled G needle.
The onset of sensory blockade time taken from the end of injection to loss of pinprick sensation at T10 dermatome and complete motor blockade time taken from the end of injection to development of grade 3 motor block , modified Bromage's criteria, highest level of sensory blockade, duration of sensory blockade two-segment regression time from highest level of sensory blockade , duration of motor blockade time required for motor blockade return to Bromage's grade I from the time of onset of motor blockade and duration of effective analgesia [time from the intrathecal injection to the first analgesic requirement, Visual Analogue Scale VAS score 3.All donkeys were allocated into one of the three groups with a 2-week washout period using a Latin Square design.
Nalbuphine has a plateau effect on respiratory depression when given on its own Elk were kept together in outdoor paddocks except during the ,2-hr observation periods when they were held individually, or in pairs, in smaller ,50 m2 outdoor observation pens. Key words This is a preview of subscription content, log in to check access. Similar results were observed in IHC analyses Fig.
Current concepts in neuraxial administration of opioids and non-opioids: an overview and future perspectives. Table 3: Outcomes produced after eliminating each study at a time. The rectal temperature appeared to be unchanged throughout the course of epidural analgesia as indicated in Table 1.
Epidural and spinal agents for postoperative analgesia. The main limitations of the present study are the use of relatively small number of donkeys in an experimental model, with only one injected total volume 5 mL.