Effect of Nalbuphine as Adjuvant to Bupivacaine for Ultrasound-Guided Supraclavicular Brachial Plexus Block

Background: Nalbuphine is a derivative of 14-hydroxymorphine which is a strong analgesic with mixed k agonist and μ antagonist. Nalbuphine was studied several times as adjuvant to local anesthetics in spinal, epidural and local intravenous block. The aim of this study was to evaluate the effect of nalbuphine as an adjuvant to local anesthetics in supraclavicular brachial plexus block. Patients and Methods: Fifty-six patients undergoing elective forearm and hand surgery under supraclavicular brachial plexus block were allocated randomly into one of two groups of 28 patients each to receive either 25 ml (0.5%) bupivacaine with 1 ml of NS or 25 ml (0.5%) bupivacaine with 1 ml (20 mg) nalbuphine. Onset time and duration of both sensory and motor block, and post-operative analgesia were observed. Result: Nalbuphine group showed significant increase in the duration of motor block (412.59 ± 18.63), when compared to control group (353.70 ± 29.019) p-value < 0.001, also, there was significant increase in sensory duration in nalbuphine group (718.14 ± 21.04) when compared to control group (610.18 ± 26.33) p-value < 0.001, without affecting the onset time of the blockade. And also, there was a significant increase in the duration of analgesic effect in nalbuphine group (835.18 ± 42.45) when compared to control group (708.14 ± 54.57) p-value < 0.001. Conclusion: The present study demonstrates that addition of 20 mg nalbuphine to bupivacaine in supraclavicular brachial plexus block is associated with significant increase in the duration of both sensory and motor block and also prolong the duration of analgesia.

Effects of Dexamethasone, Clonidine, Tramadol and Nalbuphine on Fentanyl-Induced Hyperalgesia in Rats

Opioids are drugs used to alleviate pain. However, studies have demonstrated that these drugs can cause an increase in pain sensitivity, which is called opioid-induced hyperalgesia. The objective of this study was to describe the effects of dexamethasone, clonidine, tramadol and nalbuphine on fentanyl-induced hyperalgesia in rats. After obtaining approval from the Committee for the Ethical Use of Animals (CEUA), 36 male Wistar rats were divided into 6 groups: Group 1 (GCSSL) wherein the rats received 1 ml 0.9% saline solution in two injections;Group 2 (GFTSL), received fentanyl at a dose of 100 ug·kg-1 followed by 1 ml 0.9% saline solution via intraperitoneal;the remaining groups (3, 4, 5, 6) received fentanyl at a dose of 100 ug·kg-1 following doses via intraperitoneal: Group 3 (GFTDX), dexamethasone at a dose of 1.0 mg·kg-1;Group 4 (GFTCL), clonidine at a dose of 20 mg·kg-1;Group 5 (GFTTR), tramadol at a dose of 50 mg·kg-1, and Group 6 (GFTNB), nalbuphine at a dose of 5 mg·kg-1. Under general anestesia using isoflurane, the animals were submitted to a surgical incision. Hyperalgesia was evaluated by applying Von Frey filaments at 2 hours after the incision and on the 1st, 3rd and 5th days afterward. At 2 hours after the surgical procedure, there was lower intensity of pain in the fentanyl group (GFTSL) compared to the other groups, and on the fifth day there were no significant differences for pain intensity between groups. The results suggest the presence of fentanyl-induced hyperalgesia and efficacy in its reduction by dexamethasone, clonidine, tramadol and nalbuphine.

Nalbuphine versus Dexmedetomidine as an Analgesic Additive to Lidocaine in Intravenous Regional Anesthesia IVRA

Intravenous Regional Anesthesia (IVRA) is easy to administer and reliable. But delayed onset and lack of postoperative analgesia are the major limitations. Accordingly, many additives have been tried. Dexmedetomidine is a highly selective α-2 adrenoceptor agonist. Addition of dexmedetomidine to lignocaine is effective in decreasing the anesthetic requirements and prolonging the analgesic duration. On the other hand, many theories explain that opioids may exert their peripheral action through peripheral opioid receptors. The aim of the study was to compare the analgesic efficacy of nalbuphine and dexmedetomidine when used separately as adjuvants to lidocaine during IVRA with the effect of lidocaine alone. Sixty adult patients, who were scheduled for surgery of the hand or the forearm under intravenous regional anesthesia, were included in this study. The patients were randomly allocated into three equal groups. The syringes in all groups contained 3 mg/kg of lidocaine 0.5% diluted in 40 ml isotonic saline. Group C: Control group. Group D: Dexmedetomidine group, 1 mic/kg dexmedetomidine diluted was added. Group N: Nalbuphine group, 20 mg nalbuphine was added. Sensory onset time (min) as well as motor block onset time (min) were significantly shorter in Groups N (2.0 ± 1.7) (3.8 ± 2.1) respectively, and D (2.2 ± 1.8) (4.6 ± 2.2) respectively compared to Group C (3.6 ± 1.6) (7.1 ± 1.4) (P < 0.05), with no significant differences between nalbuphine and dexmedetomidine groups. Sensory and motor block recovery times (min) were significantly longer in Groups N (9.6 ± 0.7) (10.3 ± 1.2) and D (8.1 ± 1.1) (9.1 ± 2.1) when compared to Group C (3.4 ± 2.1) (3.7 ± 3.1) (P < 0.05), without significant differences between nalbuphine and dexmedetomidine. Ramsay sedation score was significantly higher (RSS = 2) in 14 patients (70%) in Group D compared to Groups C and N during the first 30 min after the release of tourniquet.

Effect of nalbuphine preemptive analgesia combined with ropivacaine local infiltration on postoperative incision pain,stress response and immune function in children

Objective: To study the effect of nalbuphine preemptive analgesia combined with ropivacaine local infiltration on postoperative incision pain, stress response and immune function in children. Methods: Children who received selective laparotomy in Mianyang Central Hospital between August 2015 and August 2017 were selected and randomly divided into control group, nalbuphine group (N group), ropivacaine group (R group) and nalbuphine + ropivacaine group (N+R group). The levels of pain and stress-related mediators in serum and the levels of immune cells in peripheral blood were detected before operation and 24 h after operation. Results: 24 h after operation, serum Cor, NE, MDA, SP, PGE2, BK, NPY, TNF-α, IL-6 and IL-10 levels of four groups of children were significantly higher than those before operation while serum SOD and CAT levels as well as peripheral blood CD3+, CD4+ and CD8+T cell levels were significantly lower than those before operation;serum Cor, NE, MDA, SP, PGE2, BK, NPY, TNF-α, IL-6 and IL-10 levels of N group, R group and N+R group were significantly lower than those of control group while serum SOD and CAT levels as well as peripheral blood CD3+, CD4+ and CD8+T cell levels were significantly higher than those of control group;serum Cor, NE, MDA, SP, PGE2, BK, NPY, TNF-α, IL-6 and IL-10 levels of N+R group were significantly lower than those of N group and R group while serum SOD and CAT levels as well as peripheral blood CD3+, CD4+ and CD8+T cell levels were significantly higher than those of N group and R group. Conclusion: Nalbuphine preemptive analgesia combined with ropivacaine local infiltration can reduce the postoperative incision pain and stress response and improve the immune function in children.

缓释nalbuphine可能对继发于膝或髋关节炎的慢性疼痛有效

根据一项Ⅱa期临床研究的结果，Penwest公司的缓释纳布啡（nalbuphine）（Ⅰ）或许有潜力应用于继发于膝关节或髋关节骨关节炎的慢性疼痛患者。在该试验中，138名这样的患者按2：1被随机分为接受口服（Ⅰ）或安慰剂，治疗3周（试验设计为每日给药两次的片剂），（Ⅰ）在第一周服用最低剂量，在第二周服用中等剂量，在第三周服用最高剂量。关于主要终点，

A comparative study of three concentrations of intravenous nalbuphine combined with hydromorphone for post-cesarean delivery analgesia

Background:Nalbuphine has been suggested to be used for post-cesarean section(CS)intravenous analgesia.However,ideal concentration of nalbuphine for such analgesia remains unclear.The present study was conducted to explore an ideal concentration of nalbuphine for post-CS intravenous analgesia by evaluating the analgesic effects and side-effects of three different concentrations of nalbuphine combined with hydromorphone for post-CS intravenous analgesia in healthy parturients.Methods:One-hundred-and-fourteen parturients undergoing elective CS were randomly allocated to one of three groups(38 subjects per group)according to an Excel-generated random number sheet to receive hydromorphone 0.05 mg/mL+nalbuphine 0.5 mg/mL(group LN),hydromorphone 0.05 mg/mL+nalbuphine 0.7 mg/mL(group MN),and hydromorphone 0.05 mg/mL+nalbuphine 0.9 mg/mL(group HN)using patient-controlled analgesia(PCA)pump.Visual analog scale(VAS)for pain,PCA bolus demands,cumulative PCA dose,satisfaction score,Ramsay score,and side-effects such as urinary retention were recorded.Results:The number of PCA bolus demands and cumulative PCA dose during the first 48 h after CS were significantly higher in group LN(21±16 bolus,129±25 mL)than those in group MN(15±10 bolus,120±16 mL)(both P<0.05)and group HN(13±9 bolus,117±13 mL)(both P<0.01),but no difference was found between group HN and group MN(both P>0.05).VAS scores were significantly lower in group HN than those in group MN and group LN for uterine cramping pain at rest and after breast-feeding within 12 h after CS(all P<0.01)and VAS scores were significantly higher in group LN than those in groupMNand group HN when oxytocin was intravenously infused within 3 days after CS(all P<0.05),whereas VAS scores were not statistically different among groups for incisional pain(all P>0.05).Ramsay sedation scale score in groupHNwas significantly higher than that in group MN at 8 and 12 h after CS(all P<0.01)and group LN at 4,8,12,24 h after CS(all P<0.05).Conclusions:Hydromorphone 0.05 mg/mL+nalbuphine 0.7 mg/mL for intravenous PCA could effectively improve the incisional pain and uterine cramping pain management and improve comfort in patients after CS.

Flow Injection Chemiluminescence Method for Nalbuphine Hydrochloride in Pharmaceutical Formulations Using Tris(2,2′-bipyridyl)ruthenium(II)Chloride-diperiodatocuprate(III)Reaction

A sensitive and selective method employing chemiluminescence(CL)coupled with flow injection(FI)is reported for nalbuphine hydrochloride(NAL)assay in pharmaceutical formulations.The enhancement effect of NAL on the CL reaction between tris(2,2′-bipyridyl)ruthenium(II)chloride-diperiodatocuprate(III){Ru[(bpy)_(3)]^(2+)-Cu(III)complex}in acidic medium is used as analytical measurement.The optimal conditions of the CL reaction were sulfuric acid 1.0×10^(−3) mol/L,Ru[(bpy)s]2+7.5×10^(−5) mol/L,Cu(III)/Ag(III)complexes 4.0×10^(−4)/5.0×10^(−4) mol/L,sample loop volume of 120µL and flow rate of 2.5 mL/min.The sensitivities of the method in terms of detection(S/N=3)and quantification(S/N=10)limits are 5×10^(−4) and 0.001 ppm(1 ppm=1 mg/L),respectively.The linear response of the instrument in the form of CL intensity with respect to NAL concentration is over the range 0.001-15.0 ppm(R^(2)=0.9999)with relative standard deviation from 0.8%to 3.2%and injection throughput of 120 injection/h.The applications of the method include the quantitative analysis of NAL in pharmaceutical injection samples.Variations and the average results of the proposed method are not significantly different from the results of a reported method by applying F-and paired student t-test.The most likely CL reaction mechanism is written in accordance with spectrophotometric and CL studies.