Efficacy of Nalbuphine with Flurbiprofen on Multimodal Analgesia with Transverse Abdominis Plane Block in Elderly Patients Undergoing Open Gastrointestinal Surgery: A Randomized, Controlled, Double-Blinded Trial

Abstract

Objective To assess different doses of nalbuphine with flurbiprofen compared to sufentanil with flurbiprofen in multimodal analgesia efficacy for elderly patients undergoing gastrointestinal surgery with a transverse abdominis plane block (TAPB). Methods 158 elderly patients scheduling for elective open gastrointestinal surgery under general anesthesia and TAPB were randomly assigned to four groups according to different doses of nalbuphine with flurbiprofen in postoperative intravenous analgesia (PCIA). Postoperative pain intensity, effective pressing numbers of PCIA, and adverse effects were recorded at 6, 12, 24, and 48 hours after surgery. Results Postoperative pain intensity, effective pressing numbers, and the incidence of postoperative nausea and vomiting (PONV) were similar among the four groups after surgery, while the severity of PONV was decreased in Group L compared with Group S at 6, 12, and 48 h after surgery. No individual experienced pruritus, respiratory depression, or hypotension. Conclusions Low dose of nalbuphine (15 μg·kg−1·ml−1) combined with flurbiprofen is superior for elderly patients undergoing elective open gastrointestinal surgery with TAPB in terms of the efficient postoperative analgesia and decreased severity of PONV. This trial is registered with NCT02984865.

<p>Intraoperative administration of intravenous flurbiprofen axetil with nalbuphine reduces postoperative pain after orbital decompression: a single-center, prospective randomized controlled trial</p>

“…In our study, there were two and six cases of PONV in the flurbiprofen axetil and nalbuphine groups, respectively, and four cases in the combination group, but the differences were not statistically significant. Similarly, the combination of low-dose nalbuphine plus flurbiprofen has been reported to decrease the severity of PONV 13. We did not observe respiratory depression in any of the patients during the postoperative period.…”

“…Multimodal analgesia is defined as combining analgesics with different mechanisms of action within the peripheral and central nervous system to maximize analgesic efficacy and minimize side effects;13 indeed, this is the best choice for pain management 7. A combination of opioids and NSAIDs is associated with greater patient satisfaction and fewer opioid-induced adverse effects than with single-agent analgesia 14.…”

“…A combination of opioids and NSAIDs is associated with greater patient satisfaction and fewer opioid-induced adverse effects than with single-agent analgesia 14. For example, flurbiprofen combined with nalbuphine is superior for patients undergoing open gastrointestinal surgery with efficient postoperative analgesia and decreases the severity of PONV 13. However, the postoperative analgesic efficacy of these drugs in patients undergoing orbital decompression is unknown.…”

Application of Nalbuphine in Trigeminal Ganglion Pulse Radiofrequency Surgery in Patients with Postherpetic Neuralgia

“…Nalbuphine exerts a strong, fast, and enduring analgesic and sedative effect, with almost no cardiovascular adverse reactions [ 43 ], light respiratory depression, and a capping effect [ 44 , 45 ]. Many studies have confirmed the efficacy of intravenous nalbuphine in the treatment of itching caused by opioids, which can reduce patients' nausea and vomiting, and reverse adverse reactions such as respiratory depression [ 19 , 43 ]. Intravenous administration of low-dose nalbuphine (5 μ g/kg/h) in patients with epidural morphine not only maintains the analgesic effect but also reduces the occurrence of itching [ 46 ].…”

“…It has certain advantages in day surgery. Studies have shown that nalbuphine assisting nonsteroidal anti-inflammatory drugs can significantly enhance postoperative analgesia and reduce postoperative complications [ 19 ], which have a good clinical application prospect. Ketorolac has an anti-inflammatory and analgesic effect by inhibiting the biosynthesis of prostaglandins, prostacyclin, and thromboxane; however, whose postoperative analgesic effect was found to be not quite satisfactory when used alone [ 20 ].…”