&lt;p&gt;Preemptive Nalbuphine Attenuates Remifentanil-Induced Postoperative Hyperalgesia After Laparoscopic Cholecystectomy: A Prospective Randomized Double-Blind Clinical Trial&lt;/p&gt;

Hu, Jun; Chen, Shuangshuang; Zhu, Mudan; Wu, Yun; Wang, Ping; Chen, Jinbao; Zhang, Ye

doi:10.2147/jpr.s257018

Cited by 9 publications

(11 citation statements)

References 28 publications

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“…The inflammation-induced hyperexcitability of extrinsic visceral afferents is associated with nociceptive and opioid receptors [ 27 ], which are related to potentiation of hypersensitivity and hyperalgesia [ 28 ]. The results were unexpected; to the best of our knowledge, there is no report about the effect of nalbuphine on visceral hyperalgesia, although we have reported that nalbuphine can improve remifentanil-induced hyperalgesia (RIH) [ 29 ]. Perhaps the results of the current study can provide some hints for future investigation of nalbuphine in this scenario.…”

Section: Discussionmentioning

confidence: 99%

Preemptive Intravenous Nalbuphine for the Treatment of Post-Operative Visceral Pain: A Multicenter, Double-Blind, Placebo-Controlled, Randomized Clinical Trial

Liu¹,

Hu²,

Hu³

et al. 2021

Pain Ther

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Introduction: Post-operative visceral pain is common in early postoperative period after laparoscopic surgery. As a kappa opioid receptor agonist, the antinociceptive effects of nalbuphine in visceral pain are consistent across a multitude of experimental conditions irrespective of species. We hypothesized that preemptive nalbuphine can decrease the visceral pain for patients with incisional infiltration of ropivacaine after laparoscopic cholecystectomy. Methods: In a multicenter, prospective, doubleblind, placebo-controlled, randomized clinical trial, 2094 participants scheduled for laparoscopic cholecystectomy were randomly assigned to receive nalbuphine (Nal group, n = 1029) or placebo (Con group, n = 1027). The Nal group received intravenous nalbuphine 0.2 mgÁkg -1 and the Con group received saline in a similar way. The primary endpoint was the effect of nalbuphine on post-operative visceral pain intensity scores within 24 h postoperatively. The total amount of analgesic as well as complications were recorded. Results: A total of 1934 participants were analyzed. Nalbuphine reduced the visceral pain both at rest (b = -0.1189, 95% CI -0.23 to -0.01, P = 0.037) and movement (b = -0.1076, 95% CI -0.21 to -0.01, P = 0.040) compared with placebo. Patients in the Nal group required less frequent supplemental analgesic administration during the first 24 h after surgery. There were fewer patients in the Nal group who experienced nausea and vomiting (PONV) (P = 0.008). Conclusions: Preemptive nalbuphine administered at a dose of 0.2 mgÁkg -1 was safe and effective at reducing the postoperative visceral pain and supplemental analgesic use in patients undergoing laparoscopic cholecystectomy.

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Section: Discussionmentioning

confidence: 99%

Preemptive Intravenous Nalbuphine for the Treatment of Post-Operative Visceral Pain: A Multicenter, Double-Blind, Placebo-Controlled, Randomized Clinical Trial

Liu¹,

Hu²,

Hu³

et al. 2021

Pain Ther

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“…Moreover, because nalbuphine has very weak reactivity with delta (δ) receptors, this drug is expected to cause reduced irritability or anxiety 5,6 . In the clinical setting, pretreatment with nalbuphine can effectively reduce propofol‐induced injection pain and propofol consumption as well as ameliorate postoperative hyperalgesia induced by high‐dose remifentanil or sufentanil 7–9 . Nalbuphine exhibits a higher therapeutic index owing to its reduced incidence of adverse events (AEs), but has analgesic effects similar to those of morphine 10 .…”

Section: What Is Known and Objectivementioning

confidence: 99%

Pharmacokinetic comparison of nalbuphine with single injection and patient‐controlled analgesia mimic method in healthy Chinese volunteers

Zhao

et al. 2021

J Clin Pharm Ther

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What is known and objective Nalbuphine is a mu (μ) receptor partial antagonist/kappa (κ) receptor agonist analgesic and can be administered as a single injection or using patient‐controlled analgesia (PCA) in the clinical setting. However, differences in the pharmacokinetics of the two administration methods are unclear. Here, a clinical trial was performed to compare the pharmacokinetic characteristics and superiority of nalbuphine with a single‐injection or PCA‐mimic method to provide a reference for the selection of an appropriate administration method. Methods Twenty healthy individuals were divided into two groups and injected with 10 mg nalbuphine intravenously using a single‐injection or a PCA‐mimic method (2 mg once for five times with a 30‐min interval). Blood samples were collected, and safety was investigated. The liquid chromatography‐tandem mass spectrometry was adopted to determine the concentration of nalbuphine in plasma. Results and discussion The maximum concentration (Cmax) and area under concentration‐time curve (AUC0‐t) values of nalbuphine in the single‐injection and PCA groups were as follows: Cmax, 81.3 ± 24.7 and 39.8 ± 6.4 ng/ml, respectively; moreover, AUC0‐t, 110.3 ± 19.5 and 128.3 ± 23.0 h ng/ml, respectively. The effective analgesic concentration durations (EACDs) for the two administration methods were 1.39 ± 0.64 and 1.96 ± 0.91 h, respectively. Nalbuphine was well tolerated, and improvements were observed in the PCA group. What is new and conclusion Compared with those in the single‐injection group, the AUC0‐t and EACDs in the PCA group were similar, whereas Cmax was decreased significantly. Therefore, the PCA method was more suitable for the clinical application of nalbuphine injection owing to the superiority of lower concentration fluctuation and the improved safety profile.

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“…It reduced the PO visceral pain and supplemental analgesic use 21 and was also useful in ameliorating PO hyperalgesia induced by high-dose remifentanil use in LC. 22 …”

Section: Discussionmentioning

confidence: 99%

A Randomized Double-Blind Study Evaluating Intraperitoneal Ropivacaine Nebulization With and Without Nalbuphine for Post-operative Analgesia in Laparoscopic Cholecystectomy

Gowda

Govil

Kumar

et al. 2022

Turk J Anaesthesiol Reanim

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Objective: Local anaesthetics administered into the peritoneal cavity have been successfully used for post-operative pain relief in minimally invasive laparoscopic procedures. We intended to study and compare nebulized intraperitoneal ropivacaine with and without nalbuphine, with a placebo for post-operative pain relief in these surgeries. Methods: A prospective, randomized double-blinded study was conducted over a period of 1 year after institutional ethical clearance, in patients undergoing elective laparoscopic cholecystectomy. Subjects were randomized into 3 groups (S: saline, R: ropivacaine, RN: ropivacaine plus nalbuphine). The pain was assessed in the post-operative period using NRS scores (up to 24 hours). Kruskal-Wallis test was used for comparison, P < .05 was considered significant. Time to first rescue analgesia, total opioid requirement, and side effects were also recorded. Results: Groups were similar in terms of demographic data. Patients in the placebo group reported higher NRS scores than the other 2 study groups till 4 hours post-operative (earlier rescue analgesia). The addition of nalbuphine did not cause any statistically significant improvement in post-operative pain relief (NRS) as compared to ropivacaine administered alone. Intraperitoneal ropivacaine nebulization had no significant adverse effect as compared to placebo. Conclusions: Ropivacaine nebulization with or without nalbuphine is more effective than placebo for post-operative pain relief after laparoscopic cholecystectomy without significant side effects. Addition of nalbuphine to ropivacaine nebulization does not significantly improve pain relief after laparoscopic cholecystectomy.

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<p>Preemptive Nalbuphine Attenuates Remifentanil-Induced Postoperative Hyperalgesia After Laparoscopic Cholecystectomy: A Prospective Randomized Double-Blind Clinical Trial</p>

Cited by 9 publications

References 28 publications

Preemptive Intravenous Nalbuphine for the Treatment of Post-Operative Visceral Pain: A Multicenter, Double-Blind, Placebo-Controlled, Randomized Clinical Trial

Preemptive Intravenous Nalbuphine for the Treatment of Post-Operative Visceral Pain: A Multicenter, Double-Blind, Placebo-Controlled, Randomized Clinical Trial

Pharmacokinetic comparison of nalbuphine with single injection and patient‐controlled analgesia mimic method in healthy Chinese volunteers

A Randomized Double-Blind Study Evaluating Intraperitoneal Ropivacaine Nebulization With and Without Nalbuphine for Post-operative Analgesia in Laparoscopic Cholecystectomy

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