Prevention of epidural morphine-induced respiratory depression with intravenous nalbuphine infusion in post-thoracotomy patients

Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie
A D BaxterL M Dube

Abstract

The efficacy of nalbuphine, an agonist/antagonist opioid, in preventing respiratory depression from epidural morphine analgesia after thoracotomy, was assessed in a randomized double-blind placebo controlled trial. After a standardized general anaesthetic and 0.15 mg.kg-1 of epidural morphine, patients received a bolus and then a 24 h infusion of nalbuphine (200 micrograms.kg-1 + 50 micrograms.kg-1.hr-1, 100 micrograms.kg-1 + 25 micrograms.kg-1.hr-1, or 50 micrograms.kg-1 + 12.5 micrograms.kg-1.hr-1) or placebo. Blood gases, analgesia, sedation, side effects, and blood nalbuphine concentrations were assessed every two hours for the next 24 h. Fifty-three per cent of placebo-treated patients had a PaCO2 greater than 50 mmHg and 89 per cent of these received naloxone. A 200 micrograms.kg-1 bolus of nalbuphine followed by a 50 micrograms.kg-1.hr-1 infusion achieved a mean steady state blood level of 38.2 ng.ml-1 and prevented CO2 retention greater than 50 mmHg in all but two patients, neither of whom required naloxone. There was no difference in the incidence of side effects among groups, and analgesia appeared to be unaffected by nalbuphine.

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Citations

Mar 1, 1991·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·A D BaxterK Hull
Jul 1, 1992·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·M J WhiteK C Huang
Mar 1, 1994·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·A D BaxterL Goernert
Nov 14, 1997·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·J A AlhashemiC Gallant
Jun 3, 1999·The Surgical Clinics of North America·D S Stevens, W T Edwards
Jan 17, 2014·Expert Opinion on Drug Metabolism & Toxicology·Haitao YangXu Steven Xu
Jan 19, 2008·The Journal of Pain : Official Journal of the American Pain Society·Robert W GearJon D Levine
Apr 1, 1997·Anesthesia and Analgesia·S C LeeP L Tao
Jan 1, 1997·Annales Françaises D'anesthèsie Et De Rèanimation·X PaqueronI Murat
Oct 13, 2018·Pharmacology, Biochemistry, and Behavior·Rahul RaghavPunit Kumar

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