Summary
Patient-controlled analgesia (PCA, intravenous self-application of narcotics) has been studied during the early postoperative period in 40 ASA I–III patients recovering from elective major and minor surgery (20 abdominal and 20 orthopaedic operations). Doses of 3.7 mg of the new agonist-antagonist opiod analgesic nalbuphine were available on demand, whenever the patients felt that pain relief was necessary, delivered by a microprocessor-controlled injection pump (On-Demand Analgesia Computer, ODAC) in response to use of a patient-controlled manual switch. The maximum dose/h was set at 28.2 mg, with a refractory time of 1 minute between successful demands. A continuous nalbuphine infusion (0.44 mg·h−1) was administered in addition in order to prevent obstruction of the catheter.
The duration of the PCA period was 17.9 (0.4–28.0) h (median, range). During that time, 13.3 (1–45) demands per patient were recorded, resulting in median individual nalbuphine consumptions of 51.3 (8.1–1050.5) µg·kg−1·h−1. Self-administration was characterized by considerable intra- and interindividual variability. Following abdominal surgery significantly more nalbuphine was needed compared to orthopaedic patients, but it resulted in poorer pain relief. There were no statistically significant differences in drug requirements or pain scores between the sexes.
Overall efficacy and patient acceptance proved to be good. When compared with previous conventional postoperative analgesia, the effectiveness of PCA was judged superior by about 57% of patients. Side effects (nausea, sweating) occured in about 10% of patients but were usually of minor intensity. No serious circulatory or respiratory problems were observed during the period of PCA.
Patient-controlled analgesia is a promising technique for the treatment of acute pain and for clinical pain research.
Similar content being viewed by others
References
Alon E, Krayer S, Hossli G (1984) Analgesie und Nebenwirkungen von Nalbuphin (Nubain) im Vergleich zu Morphin nach Hysterektomie. Anaesthesist 33: 360–362
Angell M (1982) The quality of mercy. N Engl J Med 306: 98–99
Beaver WT, Feise GA (1978) A comparison of the analgesic effect of intramuscular nalbuphine and morphine in patients with postoperative pain. J Pharmacol Exp Ther 204: 487–496
Beaver WT, Feise GA, Robb D (1981) Analgesic effect of intramuscular and oral nalbuphine in postoperative pain. Clin Pharmacol Ther 29: 174–180
Beaver WT (1983) Measurement of analgesic efficacy in man. In: Bonica JJ (ed) Advances in pain research and therapy, vol 5. Raven Press, New York, pp 411–434
Bennett RL, Griffen WO (1983) Patient controlled analgesia. Contemp Surg 23: 75–89
Bikhazi GB (1978) Comparison of morphine and nalbuphine in postoperative pediatric patients. Anesthesiol Rev 5: 34–36
Cronin M, Redfern PA, Utting JE (1973) Psychometry and postoperative complaints in surgical patients. Br J Anaesth 45: 879–886
Dahlström B, Tamsen A, Paalzow L, Hartvig P (1982) Patient-controlled analgesic therapy, part IV: Pharmacokinetics and analgesic plasma concentrations of morphine. Clin Pharmacokinet 7: 266–279
Donovan BD (1983) Patient attitudes to postoperative pain relief. Anaesth Intensive Care 11: 125–129
Engalla JM, Jimenez H, Alejandro E (1982) Intramuscular nalbuphine HCl for the control of postoperative somatic pain. Phil J Obstet Gynecol 6: 44–49
Errick JK, Heel RC (1983) Nalbuphine. A preliminary report of its pharmacological properties and therapeutic efficacy. Drugs 26: 191–211
Fahmy NR (1980) Nalbuphine in “balanced” anesthesia: Its analgesic efficacy and hemodynamic effects. Anesthesiology 53: S66
Fragen RJ, Caldwell N (1977) Acute intravenous premedication with nalbuphine. Anesth Analg 56: 808–812
Freye E, Hartung E, Segeth M (1984). Nalbuphine reverses fentanyl-related EEG-changes in man. Acta Anaesthesiol Belg 35: 25–36
Gal TI, DiFazio CA, Moscicki I (1982) Analgesic and respiratory depressant activity of nalbuphine: a comparison with morphine. Anesthesiology 57: 367–374
Gibbs JM, Johnson HD, Davis FM (1982) Patient administration of i.v. buprenorphine for postoperative pain relief using the “Cardiff” demand analgesia apparatus. Br J Anaesth 54: 279–284
Houde RW, Wallenstein SL, Beaver WT (1965) Clinical measurement of pain. In: George DS (ed) Analgesics. Academic Press, New York, pp 75–122
Jasinski DR, Masky PA (1972) Evaluation of nalbuphine for abuse potential. Clin Pharmacol Ther 13: 78–90
Joyce CRB, Zutshi DW, Hrubes V, Mason RM (1975) Comparison of fixed intervals and visual analogue scales for rating chronic pain. Eur J Clin Pharmacol 8: 415–420
Kay B (1983) On-demand nalbuphine for post-operative pain. Anaesthesist 32 [Suppl]: 366–367
Kay B (1984) Patient-controlled analgesia. Can Anaesth Soc J 31: 120–121
Keeri-Szanto M (1979) Drugs or drums: What relieves postoperative pain? Pain 6: 217–230
Lake CL, Duckworth EN, DiFazio CA, Magruder MR (1984) Cardiorespiratory effects of nalbuphine and morphine premedication in adult cardiac surgical patients. Acta Anaesthesiol Scand 28: 305–309
Latasch L, Probst S, Dudziak R (1984) Reversal by nalbuphine of respiratory depression caused by fentanyl. Anesth Analg 63: 814–816
Lehmann KA, Gensior J, Daub D (1982) “Analgetische” Fentanyl-Blutkonzentrationen unter Neuroleptanalgesie. Anaesthesist 31: 655–659
Lehmann KA, Neubauer ML, Daub D, Kalff G (1983) CO2-Antwortkurven als Maß für eine opiatbedingte Atemdepression. Untersuchungen mit Fentanyl. Anaesthesist 32: 242–258
Lehmann KA (1984) On-Demand Analgesie: Neue Möglichkeiten zur Behandlung akuter Schmerzen. Arzneimittelforsch 34: 1108–1114
Lehmann KA, Gördes B, Hoeckle W (1985) Postoperative On-Demand Analgesie mit Morphin. Anaesthesist 34: 494–501
Lehmann KA, Tenbuhs B, Hoeckle W (1985) Postoperative On-Demand Analgesie mit Pentazocin (Fortral). Langenbecks Arch Chir 367: 27–40
Loan WB, Dundee JW (1967) The clinical assessment of pain. Practioner 198: 759–768
Loan WB, Morrison JD (1967) The incidence and severity of postoperative pain. Br J Anaesth 39: 695–698
Magruder MR, Delaney RD, DiFazio CA (1982) Reversal of narcotic-induced respiratory depression with nalbuphine hydrochloride. Anesthesiol Rev 9: 34–37
Marks RM, Sachar EJ (1973) Undertreatment of medical inpatients with narcotic analgesics. Ann Int Med 78: 173–181
Masson AHB (1967) The role of analgesic drugs in the treatment of postoperative pain. Br J Anesth 39: 713–720
Mather LE (1983) Importance of blood concentrations of narcotics: Basis of understanding, controlling, and individualizing therapy. In: Bonica JJ (ed) Advances in pain research and therapy, vol 5, Raven Press, New York, pp 461–466
Miller RR (1980) Evaluation of nalbuphine hydrochloride. Am J Hosp Pharm 37: 942–949
Murphy MR, Hug CC (1982) The enflurane sparing effect of morphine, butorphanol, and nalbuphine. Anesthesiology 57: 489–492
Nayman J (1979) Measurement and control of postoperative pain. Ann R Coll Surg Engl 61: 419–426
Okun R (1982) Analgesic effects of oral nalbuphine and codeine in patients with postoperative pain. Clin Pharmacol Ther 32: 517–524
Papper EM, Brodie BB, Rovenstine EA (1952) Postoperative pain; its use in the comparative evaluation of analgesics. Surgery 32: 107–109
Parbrook GD, Steel DF, Dalrymple DG (1973) Factors predisposing to postoperative pain and pulmonary complications. A study of male patients undergoing elective gastric surgery. Br J Anaesth 45: 21–23
Parkhouse J, Lambrechts W, Simpson BRJ (1961) The incidence of postoperative pain. Br J Anaesth 33: 345–353
Parkhouse J, Holmes CM (1963) Assessing post-operative pain relief. Proc R Soc Med 56: 579–583
Peeters M, Brugmans J (1980) Postoperative pain relief by demand analgesia. Acta Anaesthesiol Belg 31 [Suppl]: 233–237
Pflug AE (1977) Physiopathology and control of postoperative pain. Arch Surg 112: 773–781
Revill SI, Robinson JO, Rosen M, Hogg MIJ (1976) The reliability of a linear analogue for evaluating pain. Anaesthesia 31: 1191–1198
Romagnoli A, Keats AS (1980) Ceiling effect of respiratory depression by nalbuphine. Clin Pharmacol Ther 27: 478–485
Scott J, Huskisson EC (1976) Graphic representation of pain. Pain 2: 175–184
Scott LE, Clum GA, Peoples JB (1983) Preoperative predictors of postoperative pain. Pain 15: 283–293
Smith JM, Utting JE (1976) Postoperative pain. Br Med J 2: 875
Sprigge JS, Otton PE (1983) Nalbuphine versus meperidine for postoperative analgesia: a double-blind comparison using the patient controlled analgesic technique. Can Anaesth Soc J 30: 517–521
Stapleton JV, Austin KL, Mather LE (1979) A pharmacokinetic approach to postoperative pain: Continuous infusion of pethidine. Anaesth Intensive Care 7: 25–32
Stambaugh JE (1982) Evaluation of nalbuphine. Efficacy and safety in the management of chronic pain associated with advanced malignancy. Curr Ther Res 31: 393–400
Sulit BNM (1982) Intravenous nalbuphine hydrochloride for the control of post-operative somatic pain among filipinos. Phil J Anesth 6: 2–9
Sunshine A, Zighelboim I, de Sarrazin C, de Castro A (1983) A study of the analgesic efficacy of nalbuphine hydrochloride in patients with postpartum pain. Curr Ther Res 33: 108–114
Tammisto T, Tigerstedt I (1977) Comparison of the analgesic effects of intravenous nalbuphine and pentazocine in patients with postoperative pain. Acta Anaesthesiol Scand 21: 390–394
Tammisto T, Tigerstedt I (1982) Narcotic analgesics in postoperative pain relief in adults. Acta Anaesthesiol Scand 74 [Suppl]: 161–164
Tamsen A, Hartvig P, Fagerlund C, Dahlström B, Bondesson U (1982) Patient-controlled analgesic therapy: Clinical experience. Acta Anaesthesiol Scand 74 [Suppl]: 157–160
Wallace PGM, Norris W (1975) The management of postoperative pain. Br J Anaesth 47: 113–120
Waye JD, Braunfeld SF (1982) A randomized double-blind study of nalbuphine as an analgesic for colonoscopy. Gastrointest Endosc 28: 86–87
Weis OF, Sriwatanakul K, Alloza JL, Weintraub M, Lasagna L (1983) Attitudes of patients, housestaff, and nurses toward postoperative analgesic care. Anesth Analg 62: 70–74
White DC (1982) The relief of postoperative pain. In: Atkinson RS, Hewer CL (eds) Recent advances in anaesthesia and analgesia. Churchill Livingstone, Edinburgh, London, Melbourne, New York, pp 121–139
Woodforde JM, Merskey H (1972) Some relationships between subjective measures of pain. J Psychosom Res 16: 173–178
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lehmann, K.A., Tenbuhs, B. Patient-controlled analgesia with nalbuphine, a new narcotic agonist-antagonist, for the treatment of postoperative pain. Eur J Clin Pharmacol 31, 267–276 (1986). https://doi.org/10.1007/BF00981122
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00981122