Pharmacokinetics of nalbuphine during parturition

Wilson, Stephen J.; Errick, Jeffrey Keith; Balkon, Joseph

doi:10.1016/0002-9378(86)90822-7

Cited by 31 publications

(7 citation statements)

References 9 publications

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“…On the whole, the range of the F/M ratio was 0.45-1.25 in the 66 patients studied in these two series. Therefore, the placental transfer of nalbuphine definitely appears less variable than reported by Wilson et al (1986b), who found an F/M ratio ranging from 0.3 to 6.0 in five patients.…”

Section: Discussionmentioning

confidence: 52%

“…administration to patients in labour or healthy subjects follows two-compartment pharmacokinetics with an initial distribution phase of 4-20 min and a terminal elimination phase of about 2 h (Wilson et al 1986b;Jaillon et al 1989). However, at delivery, nalbuphine blood concentration has been considered to decay monoexponentially because such a monoexponential decay has been described for pethidine (Morselli and Rovei 1980).…”

Section: Discussionmentioning

confidence: 99%

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Therapeutic monitoring of nalbuphine: transplacental transfer and estimated pharmacokinetics in the neonate

Nicolle

Devillier

Delanoy

et al. 1996

Eur J Clin Pharmacol

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Nalbuphine, a mixed agonist-antagonist opiate, is commonly used as a systemic analgesic during labour. Recent reports of perinatal adverse effects prompted us to carry out therapeutic nalbuphine monitoring in obstetric analgesia. Because data on fetomaternal transfer are scarce and the pharmacokinetics of this drug in the neonate are largely unknown, we report data obtained from 28 parturients treated with nalbuphine either intramuscularly and/or intravenously during labour. Plasma nalbuphine levels were measured by high-performance liquid chromatography (HPLC) with electrochemical detection. At delivery, 30-150 min after maternal administration, nalbuphine concentrations ranged from 5.0 to 79.2 ng.ml-1 in mother plasma samples and from 3.0 to 46.6 ng.ml-1 in umbilical cord plasma samples. Nalbuphine concentrations were highly correlated to dose. The fetomaternal ratio was high: 0.74 and not correlated to the administered dose of nalbuphine. An estimated plasma half-life of 4.1 h was calculated from two determinations in the neonate based on the assumption of a monoexponential decay of nalbuphine concentrations. Apart from a flattening of the fetal heart rate tracing in 54% of the cases, only one neonate had a low Apgar score at birth. The apparent prolonged half-life of nalbuphine in the neonate indicates the usefulness of an intramuscular injection of naloxone to prevent recurrence of cardiorespiratory depression due to nalbuphine administration to the mother.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Therapeutic monitoring of nalbuphine: transplacental transfer and estimated pharmacokinetics in the neonate

Nicolle

Devillier

Delanoy

et al. 1996

Eur J Clin Pharmacol

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“…Nalbuphine pass through the placenta rapidly[1213] and the elimination half-life of nalbuphine in neonates is 4.1 hours,[14] which was shorter than that of meperidine in neonates 7-32 hours. [15] So, the neonatal effects of nalbuphine will be of shorter duration than meperidine.…”

Section: Discussionmentioning

confidence: 99%

“…Wilson et al .,[12] found that when nalbuphine was used as bolus for maternal analgesia during labor it was associated with decreased APGAR and neonatal neurobehavioral scores compared to bolus meperidine, but others studies did not find any significant effect of nalbuphine on neonatal outcome. [16–18]…”

Section: Discussionmentioning

confidence: 99%

Maternal and neonatal effects of nalbuphine given immediately before induction of general anesthesia for elective cesarean section

et al. 2011

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Background:Although nalbuphine was studied extensively in labour analgesia and was proved to be acceptable analgesics during delivery, its use as premedication before induction of general anesthesia for cesarean section is not studied. The aim of this study was to evaluate the effect of nalbuphine given before induction of general anesthesia for cesarean section on quality of general anesthesia, maternal stress response, and neonatal outcome.Methods:Sixty full term pregnant women scheduled for elective cesarean section, randomly classified into two equal groups, group N received nalbuphine 0.2 mg/kg diluted in 10 ml of normal saline (n=30), and group C placebo (n=30) received 10 ml of normal saline 1 min before the induction of general anesthesia. Maternal heart rate and blood pressure were measured before, after induction, during surgery, and after recovery. Neonates were assisted by using APGAR0 scores, time to sustained respiration, and umbilical cord blood gas analysis.Result:Maternal heart rate showed significant increase in control group than nalbuphine group after intubation (88.2±4.47 versus 80.1±4.23, P<0.0001) and during surgery till delivery of baby (90.8±2.39 versus 82.6±2.60, P<0.0001) and no significant changes between both groups after delivery. MABP increased in control group than nalbuphine group after intubation (100.55±6.29 versus 88.75±6.09, P<0.0001) and during surgery till delivery of baby (98.50±2.01 versus 90.50±2.01, P<0.0001) and no significant changes between both groups after delivery. APGAR score was significantly low at one minute in nalbuphine group than control group (6.75±2.3, 8.5±0.74, respectively, P=0.0002) (27% of nalbuphine group APGAR score ranged between 4–6, while 7% in control group APGAR score ranged between 4–6 at one minute). All neonates at five minutes showed APGAR score ranged between 9–10. Time to sustained respiration was significantly longer in nalbuphine group than control group (81.8±51.4 versus 34.9±26.2 seconds, P<0.0001). The umbilical cord blood gas was comparable in both groups. None of the neonates need opioid antagonist (naloxone) or endotracheal intubation.Conclusion:Administration of nalbuphine before cesarean section under general anesthesia reduces maternal stress response related to intubation and surgery, but decreases the APGAR score at one minute after delivery. So, when nalbuphine was used, all measures for neonatal monitoring and resuscitation must be available including attendance of a pediatrician.

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“…In a study, measurement of umbilical cord blood nalbuphine concentrations demonstrated that newborn concentrations varied substantially, ranging from one third to six times the simultaneous maternal concentration 13 . In a study, measurement of umbilical cord blood nalbuphine concentrations demonstrated that newborn concentrations varied substantially, ranging from one third to six times the simultaneous maternal concentration 13 .…”

Section: Nalbuphine Butorphanol and Pentazocinementioning

confidence: 99%

Review of Opioid Pca for Labour Analgesia

Hill

McMACKIN

2012

Fet. Matern. Med. Rev.

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The epidural route is currently the gold standard for labour analgesia, although it is not without serious consequences, especially when incorrect placement goes unrecognised. Intravascular, intrathecal and subdural placements have been reported to occur with incidences of 1 in 5000, 1 in 2900 and 1 in 4200 respectively. Until recent years there has not been a viable alternative to epidural analgesia.

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Pharmacokinetics of nalbuphine during parturition

Cited by 31 publications

References 9 publications

Therapeutic monitoring of nalbuphine: transplacental transfer and estimated pharmacokinetics in the neonate

Therapeutic monitoring of nalbuphine: transplacental transfer and estimated pharmacokinetics in the neonate

Maternal and neonatal effects of nalbuphine given immediately before induction of general anesthesia for elective cesarean section

Review of Opioid Pca for Labour Analgesia

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