Download full-text PDF. Medical Studies/Studia Medyczne ; 33/2. Review paper. Nalbuphine: some aspects of the research and. PDF | Background and Aim Nalbuphine as an adjuvant intrathecally can produce significant analgesia with minimal Download full-text PDF. NUBAIN (nalbuphine hydrochloride) is a synthetic opioid agonist-antagonist NUBAIN is available in two concentrations, 10 mg and 20 mg of nalbuphine.
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The introduction of nalbuphine to intravenous sedation with midazolam added little to There was a greater tendency for patients who received nalbuphine and . to Evaluate the Effects of Intrathecal Nalbuphine in Patients of Lower Abdominal Surgeries under. Spinal Anaesthesia. Pallavi Ahluwalia1, Amit Ahluwalia2. The agonist/antagonist analgesics, butorphanol (Stadol) and nalbuphine (Nubain ), are being increasingly employed as intravenous sedation agents;.
On the other hand, when evaluating safety, we could make comparisons with side-effects between the two opioids in different drug route. In intravenous and intramuscular administration, we found that Pooled risk ratios RRs for the incidence of adverse effects of nalbuphine versus morphine were 0.
In intrathecal and epidural administration, we can see that pooled risk ratios RRs for the incidence of adverse effects of nalbuphine versus morphine were 0.
The methods were carried out in accordance with the approved guidelines. We confined the search for full reports of randomized controlled trials. There were no language restrictions. We got hits in the Cochrane Library, and hits for PubMed.
We also reviewed citations listed in retrieved articles to identify additional studies.
Study Selection RCTs were eligible for analysis if the following criteria was met: 1 all patients should be randomly divided into nalbuphine and morphine groups; 2 Studies should evaluate efficacy and safety of nalbuphine compared with morphine; RCTs were eligible if they included at least one group receiving nalbuphine and one group receiving morphine. Two reviewers independently searched literature with the same retrieval strategy, assessed retrieved titles and abstracts, and downloaded potentially relevant articles for further assessment.
Disagreements on data extraction were resolved through discussion. Quality assessment Study quality was judged by the Jadad scale score 5 points according to the criteria proposed by Jadad and colleagues 21 , which evaluates studies based on randomization, blinding and dropouts. A study with a Jadad score between 3 and 5 was considered a high quality study Sensitivity analyse and subgroup analysis could be conducted.
Novel combinations of nalbuphine and medetomidine for wildlife immobilization.
Meta regression analysis by the stata statistical software version Tau-squared expresses remel estimate of between-study variance, and the smaller the value is, the better the goodness of fit of the model becomes. R-squared represents how much the covariate currently into the model can explain the amount of variation between the research. All P values reported are two-sided. Discussion Overall, patients were included in the meta-analysis. This meta-analysis of randomized controlled trials provides the solid evidence to date regarding the efficacy and safety comparing nalbuphine with morphine.
We discovered nalbuphine was comparable to morphine regarding analgesic efficacy. As we know, the evaluation of incidence of pain relief we extracted was not the most direct evidence, which was weakly expressed in clinical evidence for clinical effects, and thus, could not do better than the direct evidence of pain scores for evaluation.
Even so, the outcomes we provided were worth considering. In addition, study quality of included studies had been considered, and in general, none of the ten studies 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , which were made use of analyzing pain relief, was of low quality. In addition to this, allocation concealment had been evaluated, 5 of 10 studies reported allocation concealment 7 , 8 , 9 , 10 , 15 , which thus could present a more comprehensive evaluation of the possible bias in a randomized controlled study.
All studies eligible for analysis used a randomized controlled design, which improved the reliability of the evidence. The study by Etches et al. In this study, 4 patients who received epidural nalbuphine 10 mg and all 5 who received epidural nalbuphine 20 mg got inadequate analgesia, and all 6 patients who received morphine had satisfactory analgesia morphine vs.
If the study by Etches et al. The study by Baxter et al. Nalbuphine is a lipophilic semisynthetic opioid chemically related to both oxymorphone pure opioid agonist and naloxone pure opioid antagonist.
It has relatively potent m-antagonist and k-agonist activity. The m-antagonist property of nalbuphine allowed production of fewer mmediated side effects such as respiratory depression, pruritus, and vomiting [11,12]. Nalbuphine has been used for epidural analgesia in humans [13—15] and dogs [12,16].
The purpose of the present study was to study the analgesic effect of epidural nalbuphine in donkeys either alone or in combination with lidocaine compared with lidocaine alone.
Materials and Methods 2.
Animals The present study was carried out on six adult clinically healthy Baladi Egyptian donkeys three males and three females aged between 2 and 6 years old mean 3.
Before enrollment in the study, all donkeys underwent complete physical and hematological examinations to exclude the evidence of systemic disease. Study Design Each donkey was allocated into one of the three groups with a 2-week washout period using a Latin Square design. In all groups, the total volume of the injected solution was equalized to 5 mL by adding distilled water. Before each injection, food but not water was withheld for 12 hours.
Then, injection was done during standing, and proper placement of the needle was ensured by loss of resistance and by ease of injection. Injected drugs were administered slowly into the epidural space more than approximately 30 seconds by the same investigator F. Animal Evaluation Analgesia, sedation, and motor effects were assessed by the same observer E. H who was blind to the given injection.
The onset, duration, and anatomic distribution of analgesia were recorded for all groups. The analgesia was assessed each minute after the injection of drug s till the onset of analgesia was recorded and scored. The time from the onset of analgesia to the time of reappearance of response to painful stimulation was recorded as the duration of analgesia. Evaluations of analgesic, motor, and sedative effects were done at minute interval till a response to painful stimulation reoccurred.
Motor effects from epidural injection of the drug s were evaluated through testing the presence of ataxia by allowing the donkey to walk for 10 steps and observing the gait  at the same interval, and the motor effect was scored as score 1, no change in limb position from baseline; 2, mild ataxia slight stumbling but able to continue walking ; 3, moderate ataxia marked stumbling, walking but very ataxic ; and 4, severe ataxia falling.
Sedative effect was assessed based on the position of the head and neck, eye lid, and muzzle. Sedation was scored as score 1, no sedative effect; 2, slight drop of head with drooping of the upper eyelid; and 3, drooping of the muzzle. Vital parameters including heart rate, respiratory rate, and rectal temperature were recorded at baseline time 0 and at minute interval after injection till the end of the study.
Kolmogorov—Smirnov test was used to assure the normality of distribution of the obtained data. A one-way analysis of variance followed by Duncan test post hoc test was used to compare means for the heart rate, respiratory rate, and rectal temperature. The analgesia, sedation, and motor scores were analyzed using Mann—Whitney U-test.
Results Epidural injection of lidocaine, nalbuphine, and lidocaine— nalbuphine combination was simple, convenient, and well tolerated by all donkeys.
Epidural Lidocaine, Nalbuphine, and Lidocaine–Nalbuphine Combination in Donkeys
No precipitation was observed when lidocaine and nalbuphine were mixed into one solution. The duration of analgesia achieved with nalbuphine was Analgesic effect was achieved in the tail, perineum, caudal aspect of the hind limbs as well as scrotum in males, and vulva in females. The anatomical extent of analgesia produced by epidural nalbuphine was similar to that produced by lidocaine and lidocaine—nalbuphine combination.
All epidural injections resulted in penile protrusion in males, and the penis was retracted once analgesia was dissipated. Based on analgesic score, rapid and intense analgesia was produced with lidocaine—nalbuphine combination when compared with lidocaine or nalbuphine alone.
Although in the motor score, donkeys demonstrated mild ataxia with lidocaine 1. Nalbuphine-treated donkeys did not express any degree of ataxia after epidural administration.
None of the donkeys showed moderate or severe ataxia in any group. Based on sedation score, epidural nalbuphine alone or in combination with lidocaine produced mild sedation 2. Epidural opioid administration provides profound and long-lasting analgesia through its action on opioid receptors in the spinal cord . Effective analgesia has been reported with epidurally administered morphine, fentanyl, alfentanil, tramadol, and pethidine and was associated with low systemic redistribution [19—23].
On the other hand, epidurally administered morphine and fentanyl did not evoke a regional anesthesia in donkeys . The adverse effects of opioids respiratory depression, nausea, pruritus, vomiting, and urine retention require caution during selection of agent and dosage change to be used [20,21]. The prolonged duration of analgesia observed in our study after epidural nalbuphine and lidocaine—nalbuphine when compared with lidocaine alone is congruent with previously reported results of other opioids in humans and dogs [22,23].
The shorter duration of analgesia produced by epidural lidocaine or lidocaine—nalbuphine, when compared with nalbuphine alone, may be attributed to vasodilatation and increased absorption of the drug from the spinal cord into systemic blood circulation as a result of sympathetic blockade produced by lidocaine . The rapid onset of Fig. Analgesia scoring of lidocaine, nalbuphine, and lidocaine—nalbuphine groups over the study duration.
The intense analgesia achieved with lidocaine—nalbuphine combination in comparison with either lidocaine or nalbuphine alone could be attributed to the synergy of antinociceptive effects of lidocaine and nalbuphine as both of them act through separate analgesic mechanisms [9,10]. Nalbuphine increases inhibition of synaptic pain-impulse transmission by inhibiting the release of substance P from the primary afferent neurons and on postsynaptic opioid receptors to hyperpolarize the transmission cells.
Lidocaine acts primarily by inhibition of action potentials via sodium channel blockade  as well as by reduction of axonal and synaptic excitation of pain neurons through effects on substance P and calcium channels. Drugs working through separate analgesic mechanism have supraadditive or synergistic analgesic effects . The mild ataxia reported after administration of lidocaine and lidocaine—nalbuphine injections, and its absence in nalbuphine group, could be attributed to the sensory and motor block produced by lidocaine .
None of the donkeys in the present study showed severe ataxia or falling, and this could be attributed to the low volume of the treatments used. Mild sedation produced by epidural nalbuphine and lidocaine—nalbuphine combination, and its absence in lidocaine group, may be a result of the absorption of nalbuphine into the blood stream.
The heart rate did not change after epidural lidocaine as shown in Table 1.
The pharmacokinetics of intravenous, intramuscular, and subcutaneous nalbuphine in healthy subjects
Heart rate was only increased in nalbuphine and lidocaine—nalbuphine combination. Other reports of increased heart rate with lidocaine epidural analgesia have been reported [20,28]; this increase was attributed to the sympathetic nerve block and vasodilatation induced by lidocaine .
Similar increase in heat rate was reported after epidural injection of other opioids tramadol , and this increase was explained as tramadol may cause serotonin syndrome leading to increased heart rate and blood pressure . The rectal temperature appeared to be unchanged throughout the course of epidural analgesia as indicated in Table 1. The main limitations of the present study are the use of relatively small number of donkeys in an experimental model, with only one injected total volume 5 mL.
Further studies should be directed toward using nalbuphine—lidocaine combination for epidural anesthesia in clinical practice in a large number of animals with different doses. In conclusion, nalbuphine alone produces analgesia of long duration but of slow onset.
The combination of lidocaine—nalbuphine administered epidurally in donkeys resulted in rapid onset 6.
Epidural and spinal anesthesia and analgesia in the equine. Clin Tech Equine Pract ;—Elk were kept together in outdoor paddocks except during the ,2-hr observation periods when they were held individually, or in pairs, in smaller ,50 m2 outdoor observation pens.
Based on initial success, we conducted follow-up trials to assess alternative NalMed formulations successively modified to improve field usability, striving to shorten induction within a dose volume range that accommodated practical remote delivery. Tumor sizes were measured in perpendicular dimensions using calipers. Results: The onset of both sensory and motor blockade was faster with addition of 0.
Our previous results demonstrated that morphine and fentanyl could promote the development of breast cancer cells with stem-like phenotypes [ 2 , 3 ], but little is known about the effect of nalbuphine on cancer stem-like properties. Except for pain relief, there are many aspects to evaluate the effect of drugs, such as speed of drug action, efficacy of maintaining time, and pain scores.
The control group of mice received an equal volume of PBS. The results are expressed as mean, standard deviation and range values. Rapid and intense analgesia was produced with lidocaine—nalbuphine combination when compared with lidocaine or nalbuphine alone. Lance,2 David K.
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