Effect of adding nalbuphine to intrathecal bupivacaine with morphine on postoperative nausea and vomiting and pruritus after elective cesarean delivery: a randomized double blinded study

Ibrahim, Abdelrady S; Aly, Mahmoud; Thabet, Mostafa E; Abdelaziz, Mohamed R

doi:10.23736/s0375-9393.18.12751-9

Cited by 14 publications

(11 citation statements)

References 27 publications

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“…The primary outcome showed that nalbuphine increased the duration of analgesia by a mean difference of 3.1 hours compared to placebo, suggesting the clinical significance of this result. Also, our findings were supported by the results of previous studies 40‐45 . However, it should be acknowledged that the certainty of evidence (GRADE) was moderate due to high heterogeneity, and meta‐regression and sensitivity analyses failed to explore sources of heterogeneity.…”

Section: Discussionsupporting

confidence: 85%

A meta‐analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper‐limb orthopaedic trauma surgery

Shi

Dong

Chen

et al. 2022

International Wound Journal

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The adjuvant effectiveness of nalbuphine in context of brachial plexus block (BPB) in patients undergoing upper‐limb orthopaedic trauma surgery has remained uncertain. The purpose of this meta‐analysis was to evaluate the analgesic benefit of mixing nalbuphine into local anaesthetics in BPB for wound pain from upper‐limb trauma surgery. Primary outcome was the duration of analgesia. Seventeen trials (1104 patients) were analysed. Patients receiving nalbuphine have an increased weighted mean difference (WMD) 95% confidence interval of the duration of analgesia by 186.91 minutes (133.67 to 240.16) (P < 0.001). Compared to placebo, nalbuphine shorten the onset time of sensory and motor block by WMD of 2.59 (1.27 to 3.92) and 3.06 minutes (1.65 to 4.48) (P < 0.001), respectively. Meanwhile, nalbuphine prolonged the durations of sensory and motor block (P < 0.001). Qualitative and quantitative synthesis revealed no differences with regard to the outcomes related to side‐effects. There is moderate‐quality evidence that the addition of nalbuphine to local anaesthetics for BPB in patients undergoing upper‐limb orthopaedic trauma surgery significantly prolongs the duration of analgesia, while preserving a similar safety‐profile compared with local anaesthetics alone. However, these benefits should be further weighed against nalbuphine‐related neurological safety in future studies.

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Section: Discussionsupporting

confidence: 85%

A meta‐analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper‐limb orthopaedic trauma surgery

Shi

Dong

Chen

et al. 2022

International Wound Journal

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“…However, Group ND revealed significantly lower incidence rates of nausea and vomiting, and pruritus than the Group SD. These outcomes were indirectly supported by other studies indicating the addition of nalbuphine in parturients undergoing cesarean delivery contributed to lower incidence of postoperative adverse reactions including nausea, vomiting and pruritus ( Ibrahim et al, 2019 ). Tubog et al (2019) also proved that reduced incidence of pruritus induced by neuraxial opioids was relevant with the use of nalbuphine.…”

Section: Discussionsupporting

confidence: 62%

Analgesic Effects and Safety of Dexmedetomidine Added to Nalbuphine or Sufentanil Patient-Controlled Intravenous Analgesia for Children After Tonsillectomy Adenoidectomy

Jia

Wang

et al. 2022

Front. Pharmacol.

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Tonsillectomy is a frequently performed surgical procedure in children, requiring post-operative analgesia. This study evaluated the efficacy and safety of nalbuphine or sufentanil combined with dexmedetomidine for patient-controlled intravenous analgesia (PCIA) after pediatric tonsillectomy adenoidectomy. A total of 400 patients undergoing tonsillectomy with and without adenoidectomy were included in the study. Patients received a PCIA pump (0.5 mg/kg nalbuphine, 2 μg/kg dexmedetomidine and 0.9% sodium chloride to a total volume of 100 ml) for postoperative pain management were classified into Group ND (n = 200). Patients received a PCIA pump (2 μg/kg sufentanil, 2 μg/kg dexmedetomidine and 0.9% sodium chloride to a total volume of 100 ml) for postoperative pain management were classified into Group SD (n = 200). More stable hemodynamic changes were noted in Group ND than Group SD from 1 h to 48 h after operation. At 6, 12, 24, and 48 h after operation, the children in Group ND had higher Ramsay sedation scores than those in Group SD. The times to push the PCIA button in Group ND and Group SD were 2.44 ± 0.74 and 2.62 ± 1.00, showing significant differences (p = 0.041). The VASR scores of children in Group ND were significantly lower within 6, 12, and 24 h than those in Group SD (p < 0.05). The VASC scores of children in Group ND were significantly lower within four time points (2, 6, 12, and 24 h) than those in Group SD (p < 0.05). At 1st day after surgery, the children in Group ND had lower levels of serum ACTH, IL-6, and COR levels than those in Group SD (p < 0.001). The incidence rates of nausea and vomiting, and pruritus were significantly higher in Group SD than Group ND (5.00% vs. 11.00%, p = 0.028; 1.00% vs. 4.50%, p = 0.032). The total incidence rate of adverse reactions was significantly higher in Group SD than Group ND (15.00% vs. 31.00%, p = 0.0001). The study demonstrated that dexmedetomidine added to nalbuphine PCIA enhanced the analgesic effects, attenuated the postoperative pain, and reduced the stress response after pediatric tonsillectomy adenoidectomy.

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“…In addition, it can antagonize the activation of the µ receptor, so it may decrease the incidence of side effects when given in conjunction with or after administration of mu‐agonist opioid analgesics 33 . Ibrahim et al found that the incidence and severity of postoperative nausea, vomiting, and pruritus were significantly reduced when adding nalbuphine to the mixture of bupivacaine and morphine in patient who underwent a cesarean section delivery, without affecting the analgesic effect 34 . This finding was comparable with the meta‐analysis reported by Tito et al 35 Some studies also compared the effect of nalbuphine and fentanyl when adding to LAs in spinal anesthesia, and found that nalbuphine and fentanyl group both had better anesthetic effect, but the nalbuphine group had significantly lower side effects than the fentanyl group, and was more effective for the childbirth pain 18,36 .…”

Section: Discussionmentioning

confidence: 99%

Nalbuphine for spinal anesthesia: A systematic review and meta‐analysis

Zhang

Wang

2021

Pain Practice

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Purpose Various adjuvants for prolongation of intra‐operative and postoperative analgesia have been clinically studied, but the safety and efficiency of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia remains unconfirmed. Therefore, we conducted a meta‐analysis about the effect of nalbuphine as an adjuvant to local anesthetics in spinal anesthesia in regard to time of onset of sensory blockade and motor blockade, duration of motor blockade, 2‐segment sensory regression time, the duration of analgesia, and incidence of side effects to provide a reliable basis for clinical application. Methods Databases, including PubMed, Cochrane, EMBASE, Web of Science, CNKI, CBM, WanFang, and Viper, were searched for eligible studies. Data were extracted according to the proposed inclusion and exclusion criteria, RevMan version 5.3 and Stata 16 were selected to perform meta‐analysis. Results Eighteen published studies including 1633 patients met the inclusion criteria. The results showed that adding nalbuphine to local anesthetics for spinal anesthesia can prolong two‐segment sensory regression time (mean difference [MD] = 24.31; 95% confidence interval [CI] = 19.61–29.00, p < 0.001) and the duration of analgesia (MD = 118.11; 95% CI = 71.34–164.89, p < 0.001) without significantly increasing the incidence of adverse reactions in comparison to normal saline group. In addition, the analgesic effect of nalbuphine group was not statistically different from that of control group when compared with the potent opioid group, but the occurrence of hypotension (risk ratio [RR] = 0.35, 95% CI = 0.18–0.68, p < 0.01), the occurrence of shivering (RR = 0.19, 95% CI = 0.08–0.43, p < 0.01), and the occurrence of pruritus (RR = 0.23, 95% CI = 0.10–0.53, p < 0.01) was lower than the potent opioid group. Conclusions Nalbuphine as additives to local anesthetics can significantly prolong the two segments of sensory block and the average duration of analgesia without increasing the incidence of adverse reactions when compared with normal saline group. In addition, the analgesic efficacy of nalbuphine served as an adjunct to local anesthetics was clinically not different from that of the potent opioids, but the occurrence of hypotension, shivering, and pruritus was lower than the potent opioids.

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Effect of adding nalbuphine to intrathecal bupivacaine with morphine on postoperative nausea and vomiting and pruritus after elective cesarean delivery: a randomized double blinded study

Cited by 14 publications

References 27 publications

A meta‐analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper‐limb orthopaedic trauma surgery

A meta‐analysis showing the quantitative evidence base of perineural nalbuphine for wound pain from upper‐limb orthopaedic trauma surgery

Analgesic Effects and Safety of Dexmedetomidine Added to Nalbuphine or Sufentanil Patient-Controlled Intravenous Analgesia for Children After Tonsillectomy Adenoidectomy

Nalbuphine for spinal anesthesia: A systematic review and meta‐analysis

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