Cardiovascular Effects of Nalbuphine in Patients with Coronary or Valvular Heart Disease

Lake, Carol L.; Duckworth, Elizabeth N.; DiFazio, Cosmo A.; Durbin, Charles G.; Magruder, Michael R.

doi:10.1097/00000542-198212000-00012

Cited by 44 publications

(16 citation statements)

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“…The comparably small sympathetic hemodynamic responses to endotracheal intubation during propofol induction, especially in combination with a narcotic agent (9), determined our choice of drugs. It seems unlikely that the observed change from supraventricular tachycardia to sinus rhythm in our patient was caused by nalbuphine because it has been found to leave myocardial function unaltered (10). We are unaware that nitrous oxide may affect myocardial conduction or sinus node automaticity.…”

Section: Discussionmentioning

confidence: 71%

Change of Ectopic Supraventricular Tachycardia to Sinus Rhythm During Administration of Propofol

Hermann

Vettermann

1992

Anesthesia & Analgesia

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Section: Discussionmentioning

confidence: 71%

Change of Ectopic Supraventricular Tachycardia to Sinus Rhythm During Administration of Propofol

Hermann

Vettermann

1992

Anesthesia & Analgesia

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“…12 13 Haemodynamic changes, even in patients with cardiac disease, are reported to be minor. 14 Some researchers have voiced concerns about the use of nalbuphine by paramedics, especially the potential for delay at the scene 15 and the possibility of antagonism of other opioids, should further analgesic therapy be required after arrival at hospital. 16 However, other authors have not observed these effects.…”

Section: Introductionmentioning

confidence: 99%

Hitting them where it hurts? Low dose nalbuphine therapy

Woollard

Jones²,

Pitt³

et al. 2002

Emergency Medicine Journal

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Objective: To determine if low dose nalbuphine provides an adequate reduction in pain with minimal side effects. Methods: Prospective cohort of 115 patients given nalbuphine by paramedics in Wales and the English borders. Outcome measures: (1) Mean total dose of nalbuphine administered, change in pain score, time to adequate pain relief (score below four), and change in respiratory rate and systolic blood pressure; (2) proportion of patients continuing to suffer moderate to severe pain on arrival at hospital; (3) incidence of adverse events. Results: Full data were obtained for all patients. The mean total dose of nalbuphine administered was 6.09 mg (range 2.5 to 12.5 mg). This was significantly higher in trauma than ischaemic chest pain patients (7.03 versus 5.13 mg). The mean reduction in pain score was −3.97 (95% CI −4.38 to −3.57, p<0.001). The mean time to adequate pain relief (where this was achieved) was 15.7 minutes (95% CI 13.4 to 17.9 minutes). On arrival at hospital 60% of patients (n=69, 95% CI 50.9 to 68.5%) still met ambulance criteria for analgesia (70.7% of trauma patients and 49.1% with ischaemic chest pain). Systolic blood pressure fell by a mean of −3.67 (95% CI −6.76 to −0.58, p=0.02) and respiratory rate increased by a mean of 1.63 (95% CI 1.08 to 2.17, p<0.001). Two patients complained of nausea (1.74%, 95% CI 0.5 to 6.0%). No other adverse events were reported. Conclusion: Low dose nalbuphine results in few adverse events, but offers poor pain control for a high proportion of patients. RESEARCH OBJECTIVESResearch question Does a low dose nalbuphine dosing regimen provide an adequate reduction in pain score with minimal side effects? Research aimsTo determine: (1) the mean total dose of nalbuphine administered; (2) the mean change in pain score; (3) the mean time to adequate pain relief (pain score below four) from the start of the first dose; (4) the proportion of patients continuing to suffer moderate to severe pain on arrival at hospital; (5) the proportion of patients receiving further analgesia after hospital admission; (6) the mean post-nalbuphine change in: (a) respiratory rate; (b) blood pressure; (7) the incidence of adverse events such as nausea, vomiting or dizziness. BACKGROUND

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“…After questioning the patient, the observer rated PI by circling a number from 0 to 10, where 0 = no pain; 1-2 = mild; 3-5 = moderate; 6-8 = moderately severe; 9-10 = severe pain. PAR was rated by the observer on a 5-point ordinal scale: none (1), slight (2), moderate (3), good (4), complete (5). PAR scores were summed over the 120-minute period to yield a total pain relief score (TOTPAR).…”

Section: Methodsmentioning

confidence: 99%