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Analgesics during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
An opiate analgesic given parenterally for moderate to severe pain, nalbuphine may also be used an adjunct to balanced general anesthesia or regional techniques. Nalbuphine crosses the placenta readily. As with other narcotics, nalbuphine may result in neonatal respiratory depression, fetal and neonatal addiction, fetal cardiac function alterations, and withdrawal symptoms in the newborn. This drug was associated with a sinusoidal fetal heart rate pattern, similar to that produced by alphaprodine (Feinstein et al., 1986).
Analgesia And Anesthesia
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Michele Mele, Valentina Bellussi, Laura Felder
The disadvantages of CSE are similar to epidural and spinal techniques. Although data are limited, no differences are reported between IV preloading and no preloading to prevent hypotension [45]. Women who receive intrathecal opioids experience more pruritus than with a standard epidural [51]. However, pruritus is quite common after both spinal and epidural opioids and results from mu-opioid receptor stimulation in the brainstem. Naloxone and nalbuphine are effective interventions. Diphenhydramine and other antihistamines are not effective in treating opioid-induced pruritus because opioids administered via the intrathecal or epidural route do not cause histamine release. The significantly higher incidence of urinary retention, instrumental deliveries, and rescue analgesia interventions with traditional high-concentration epidurals would favor the use of low-dose epidurals [51]. An additional disadvantage is that the correct placement of the catheter in the epidural space cannot be verified until the spinal analgesia regresses. It is not possible to draw any meaningful conclusions as to possible differences between CSE and epidurals in producing rare complications such as nerve injury and meningitis.
Anesthesia and analgesia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The agonists/antagonists nalbuphine and butorphanol have also been widely used in many institutions for labor analgesia. These drugs act primarily at the kappa receptor and more weakly at the mu receptor (18). Their advantage over pure opiates is a ceiling effect on respiratory depression. When compared with meperidine, nalbuphine causes less maternal nausea and vomiting, but lower neonatal neurobehavioral scores at 2 to 4 hours of age (26). Butorphanol, when compared with meperidine, affords similar degrees of pain relief (27). Like nalbuphine, there is less maternal nausea and vomiting compared with meperidine. Fetal and neonatal effects are similar when comparing butorphanol and meperidine (28).
New and emerging treatments for vaso-occlusive pain in sickle cell disease
Published in Expert Review of Hematology, 2019
Nalbuphine is a partial mu-opioid receptor antagonist and complete kappa-opioid receptor agonist. Because of these mixed agonist-antagonist opioid receptor activities, nalbuphine provides analgesia with less nausea, pruritus, and respiratory depression then other mu-opioid receptor agonists, such as morphine [78]. While unfamiliar to many clinicians, nalbuphine can be useful for sickle pain of mild to moderate intensity requiring intravenous therapy, particularly in patients with a history of intense mu-agonist-induced pruritis or nausea/emesis, and may reduce the frequency of VOC-related acute chest syndromes [79]. Some individuals with refractory pain on nalbuphine may need to be converted to agents with full mu-opioid receptor activity. It also may not be suitable for patients on chronic mu-opioid receptor agonists as nalbuphine’s partial mu-opioid receptor antagonist activity may participate opioid withdrawal symptoms.
Comparison of analgesic efficacy of ultrasound-guided erector spinae block with port site infiltration following laparoscopic cholecystectomy
Published in Egyptian Journal of Anaesthesia, 2023
Magdy Mohammed Mahdy, Essam Ezzat Abdelhakeem, Ayman Mohamed Fawzy, Mostafa Samy Abbas
We found that group A provided adequate pain relief with no major adverse effects. As shown by the statistically significant prolonged time of first analgesic request, statistically significant decrease in the total amount of nalbuphine consumption as first-line rescue analgesic (8.27 ± 1.12 mg compared to 15.92 ± 2.11 mg in group B). Ten participants in group A needed ketorolac as second-line rescue analgesic, while all participants in group B needed ketorolac. The total amount of paracetamol consumption was 1.59 ± 0.50 gm in group A while in group B, it was 2.77 ± 0.43 gm. Also, there was a significantly lower numerical rate score at rest and when coughing along 24 h postoperative in group A when compared to group B.
Emerging drugs in the treatment of chronic cough
Published in Expert Opinion on Emerging Drugs, 2023
Danica Brister, Mustafaa Wahab, Moaaz Rashad, Nermin Diab, Martin Kolb, Imran Satia
Low-dose opioids are part of the current management of severe RCC/UCC and are included in current guidelines. However, many cannot tolerate the side effects of drowsiness, dizziness, constipation, nausea, and unsteadiness. Nalbuphine is a an extended-release (ER) oral formulation of the dual-acting κ-opioid receptor agonist/µ-opioid receptor antagonist. A randomized, double-blind, placebo-controlled crossover trial of nalbuphine for RCC secondary to IPF has reported interim results on 26 patients. The interim results demonstrate a 55% placebo adjusted reduction in 24-h cough frequency at day 22 [86]. Full trial results are expected in 2023/2024.