A double-blind investigation was undertaken to compare the eJjcacy if ncalbupkine and fenranyl in the preventiorr of pain nfteiday case termination qf pregnancy. Forty patients were allocated randomly to receive nalbuphine 0.25 ivig/kg or ,fentunyl J.5 pg/kg immediately before induction of anaesthesia. The patients completed scores fur pain and nausea. and perjbrmed a reaction time test to assess recovery. An observer assessed patient appearance at I , 2 und 4 hours postoperativelj!. Patierits u'ho received nalbuphine had signijcantly lower pain scores ut I hour ( p < 0.01) and 2 haurs (p < 0.05) and required sign$cantly ( p < 0.05) less postoperative analgesia. N o signjfcant diferenws were f h n d between the groups jor incidence of nausea or .for observer assessment of appearance. There was .some evidence ofp.~2vchomotor impairment at 2 hours in the nalbuphine group. Freedom from Controlled Drug Act regulutions and improved analgesia with nalbuplrine, render. it more sntisfiiciory .for day case surgery than the more commonly used.fentanyl. Anaesthesiu; outpatient. A rirrlge.rii~s, nariwt ic; fen1 any I, n al buphine.Approximately 1 SO 000 krminations of pregnancy arc performed annually in England and Wales. Eighty-five percent of procedures arc vacuum aspirations performed under general anaesthesia at less than 14 weeks' gestation. Day case surgery offers efficient use of manpower and facilities and is preferred by many patients, yet in 1982 less than 30%) were performed in this way. Several anaesthetic techniques havc been described for day case surgery' but none is ideal.Day case surgery requires adequate depth of anaesthesia with rapid recovery. The treatment ol' postoperative pain is frequently forfeited to achieve this. Collins et al.' observed moderate t o severe pain in 36% or patients following termination of prcgaancy and 480/0 required postoperative analgcsia. Hackctt ct ( 1 1 .~ noted in a similar study that approximately 30% of patients complained of moderate to severe pain and 42% rcquircd analgesia. Many techniqucs have been described that use the shorteracting opioids fcntanyl and alfentanil for termination of pregnancy but thcsc drugs offcr little pain relief in the recovery period. Nalbuphinc is a partial kappa agonistimu antagonist opioid of the phenanthrene series which was synthesised in an attempt lo produce analgesia without the undcsirablc side effects of a mu agonist, notably respiriztory depression and drug dependence. It has been dernonstratcd to exhibit a ceiling effect to both respiratory dcprcssioii and analgesia,'.* with a lower incidence ofnausea and vomiting than m~r p h i n e .~ but has nevertheless been shown by some observers to provide satisfactory postoperative analgesia following abdominal and orthopaedic surgery."-"The pharmacological profile of nalbuphine and its freedom from control by the Misuse 0fDrug.r Act would appear to be useful properties in an analgesic for day case surgery. Fentanyl is one of the more commonly used analgesics in this situation and we therefore ...
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