Abstract
The effect of nalbuphine on the respiratory depression, pruritus and analgesia induced by epidural morphine was determined in a randomized, prospective, double-blind, placebo-controlled fashion. Twenty ASA physical status I women received 0.1 mg·kg-1 epidural morphine at induction of general anaesthesia for elective total abdominal hysterectomy. Group 1 (n = 14) received 0.3 mg·kg-1 nalbuphine intravenously six hours after the epidural morphine administration. Group 2 (n = 6) received saline. Prior to agent administration, six patients from the nalbuphine group and four patients from the saline group had respiratory depression indicated by a PaCO2 greater than 45 mmHg. After nalbuphine administration the PaCO2 (mean ± SE) decreased from 49.5 ± 1.2 mmHg to 42.5 ± 0.7 mmHg (p < 0.005) while there was no significant change after saline administration. Nine of the 14 patients receiving nalbuphine appeared to become more sedated, despite an improvement in ventilation. Pruritus was antagonized by 0.1 mg·kg-1 nalbuphine (p < 0.006). There was no reversal of analgesia after administration of 0.3 mg·kg-1 nalbuphine.
Résumé
Les auteurs ont étudié ľeffet de la nalbuphine sur la dépression respiratoire, le prurit et ľanalgésie produits par la morphine administrée par voie épidurale. Ľétude fut conduite à double insu, prospectivement et avec placebo. Vingt patientes ASA I reçurent 0.1 mg·kg-1 de morphine par voie épidurale à ľinduction de ľanesthésie générale pour une hystérectomie abdominale élective. Les patientes du groupe I (n = 14) reçurent 0.3 mg·kg-1 de nalbuphine intraveneusement six heures après ľadministration de la morphine épidurale. Les patientes du group II (n = 6) reçurent du placebo. Avant ľadministration de ces agents, six patientes du premier groupe et quatre du deuxième groupe avaient une dépression respiratoire manifestée par un PaCO2 plus élevé que 45 mmHg. Les patientes furent assignées ľun ou ľautre de ces groupes au hazard. Après ľadministration de la nalbuphine, le PaCO2 fut réduit de 49.5 ± 1.2 mmHg à 42.5 ± 0.7mmHg (p < 0.005) alors qu’il n’y eut aucune amélioration après ľadministration du placebo. Ľamélioration du PaCO2 démontrée après ľadministration de la nalbuphine se manifesta en dépit ďune augmentation du niveau de sédation observé chez ces patientes. Le prurit fût antagonisé par 0.1 mg·kg-1 de nalbuphine (p < 0.006). Ľanalgésie produite par la morphine épidurale ne fût pas antagonisée après ľadministration intraveneuse de 0.3 mg·kg-1 de nalbuphine.
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Penning, J.P., Samson, B. & Baxter, A.D. Reversal of epidural morphine-induced respiratory depression and pruritus with nalbuphine. Can J Anaesth 35, 599–604 (1988). https://doi.org/10.1007/BF03020347
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DOI: https://doi.org/10.1007/BF03020347