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Patient-controlled epidural analgesia: interactions between nalbuphine and hydromorphone.
Anesth Analg. 1997 Apr; 84(4):757-63.A&A

Abstract

Epidural opioid analgesia can offer advantages over intravenous administration, however, opioid-related side effects are common after epidural administration. We studied the effect of adding nalbuphine (NB), an opioid agonist-antagonist, to hydromorphone (HM) for patient-controlled epidural analgesia (PCEA) in 78 healthy women after elective cesarean delivery. Patients were randomly assigned to one of four treatment groups. The control group received preservative-free HM (Dilaudid) alone, 0.075 mg/mL, while the three study groups received HM, 0.075 mg/mL, containing preservative-free NB (Nubain) 0.02, 0.04, or 0.08 mg/mL. Intraoperatively, all patients received epidural bupivacaine 0.5%. Postoperatively, a patient-controlled anesthesia (PCA) device was connected to the epidural catheter and programmed to deliver a 3-mL loading dose of the analgesic solution. Subsequently, patients could self-administer 2 mL bolus doses on demand with a 30-min lockout interval. Patients were encouraged to ambulate approximately 8 h after surgery, and PCEA therapy was discontinued when a clear liquid diet was tolerated. Visual analog scale scores were used to assess pain at 8-h intervals while using PCEA therapy. Although the overall incidences of nausea (19%-35%) and pruritus (32%-62%) were similar in all four groups, the addition of NB decreased the need for bladder catheterization. The highest NB concentration resulted in increased PCA demands during the 32-h study period. In conclusion, the combination of HM 0.075 mg/mL and NB 0.04 mg/mL resulted in lower nausea scores and a decreased incidence of urinary retention compared with HM alone, without increasing the opioid analgesic requirement.

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Authors+Show Affiliations

Parker RK
Department of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts, USA.
Holtmann B
No affiliation info available
White PF
No affiliation info available

MeSH

AdultAnalgesia, EpiduralAnalgesia, ObstetricalAnalgesia, Patient-ControlledAnalgesics, OpioidDose-Response Relationship, DrugFemaleHumansHydromorphoneNalbuphinePregnancy

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

9085953

Citation

Parker, R K., et al. "Patient-controlled Epidural Analgesia: Interactions Between Nalbuphine and Hydromorphone." Anesthesia and Analgesia, vol. 84, no. 4, 1997, pp. 757-63.
Parker RK, Holtmann B, White PF. Patient-controlled epidural analgesia: interactions between nalbuphine and hydromorphone. Anesth Analg. 1997;84(4):757-63.
Parker, R. K., Holtmann, B., & White, P. F. (1997). Patient-controlled epidural analgesia: interactions between nalbuphine and hydromorphone. Anesthesia and Analgesia, 84(4), 757-63.
Parker RK, Holtmann B, White PF. Patient-controlled Epidural Analgesia: Interactions Between Nalbuphine and Hydromorphone. Anesth Analg. 1997;84(4):757-63. PubMed PMID: 9085953.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient-controlled epidural analgesia: interactions between nalbuphine and hydromorphone. AU - Parker,R K, AU - Holtmann,B, AU - White,P F, PY - 1997/4/1/pubmed PY - 1997/4/1/medline PY - 1997/4/1/entrez SP - 757 EP - 63 JF - Anesthesia and analgesia JO - Anesth Analg VL - 84 IS - 4 N2 - Epidural opioid analgesia can offer advantages over intravenous administration, however, opioid-related side effects are common after epidural administration. We studied the effect of adding nalbuphine (NB), an opioid agonist-antagonist, to hydromorphone (HM) for patient-controlled epidural analgesia (PCEA) in 78 healthy women after elective cesarean delivery. Patients were randomly assigned to one of four treatment groups. The control group received preservative-free HM (Dilaudid) alone, 0.075 mg/mL, while the three study groups received HM, 0.075 mg/mL, containing preservative-free NB (Nubain) 0.02, 0.04, or 0.08 mg/mL. Intraoperatively, all patients received epidural bupivacaine 0.5%. Postoperatively, a patient-controlled anesthesia (PCA) device was connected to the epidural catheter and programmed to deliver a 3-mL loading dose of the analgesic solution. Subsequently, patients could self-administer 2 mL bolus doses on demand with a 30-min lockout interval. Patients were encouraged to ambulate approximately 8 h after surgery, and PCEA therapy was discontinued when a clear liquid diet was tolerated. Visual analog scale scores were used to assess pain at 8-h intervals while using PCEA therapy. Although the overall incidences of nausea (19%-35%) and pruritus (32%-62%) were similar in all four groups, the addition of NB decreased the need for bladder catheterization. The highest NB concentration resulted in increased PCA demands during the 32-h study period. In conclusion, the combination of HM 0.075 mg/mL and NB 0.04 mg/mL resulted in lower nausea scores and a decreased incidence of urinary retention compared with HM alone, without increasing the opioid analgesic requirement. SN - 0003-2999 UR - https://www.unboundmedicine.com/medline/citation/9085953/Patient_controlled_epidural_analgesia:_interactions_between_nalbuphine_and_hydromorphone_ L2 - https://doi.org/10.1097/00000539-199704000-00011 DB - PRIME DP - Unbound Medicine ER -