• The Korean Journal of Pain
• /
• v.5 no.2
• /
• pp.221-228
• /
• 1992

The effect of epidural nalbuphine on pruritus, nausea, vomiting, voiding difficulties and/or analgesia induced by epidural morphine was determined in sixty Cesarian delivery patients. They were physical status 1 or 2 by ASA classification and randomly divided into three groups. They were administered morphine 3 mg only(group A), nalbuphine 5 mg with morphine 3 mg(group B), or nalbuphine 10 mg with morphine 3 mg(group C) at the time of peritoneal closure. During postoperative 24 hours their analgesic effects were evaluated by visual analogue scale(0~10). Respiratory rates, Trieger dot test and severity of side effects(0~2) were also evaluated. The results were as follows; 1) Analgesic duration of the first epidural administration was significantly long in group A than other groups, but there was no difference between that of group B and group C. 2) Pruritus was more severe in group A than other groups but the severity was decreased by increasing nalbuphine dosage. 3) Nausea and or vomiting was mild in group C and the incidence of nausea and/or vomiting combined with pruritus was decreased by increasing nalbuphine dosage. 4) Voiding difficulties was more severe in group A than other groups but the severity was not decreased by increasing nalbuphine dosage. 5) None of the patients had objective sedation or low respiration rate(< 10 times/minute). We concluded that epidural administration of nalbuphine 10 mg with morphine 3mg for post-Cesarean section pain management is one of good methods to reduce side effects induced by epidural morphine.

• The Korean Journal of Pain
• /
• v.10 no.1
• /
• pp.48-53
• /
• 1997

Background : Epidural morphine provides excellent postoperative analgesia but is often associated with side effects such as nausea, vomiting and pruritus. It has been reported that mixed agonist-antagonist, nalbuphine can reverse side effects of epidural morphine without compromising analgesia. This study was designed to compare the efficacy of each intravenous dose of nalbuphine for treatment of side effects following epidural morphine. Methods : All patients received continuous infusion(2 ml/hr) of epidural morphine-local anesthetics mixture(morphine 4 mg, 1% mepivacaine 50 ml and 0.25% bupivacaine 50 ml) following a loading dose (morphine 2 mg with 1% mepivacaine 7 ml). Patients requesting treatment for nausea, vomiting and pruritus randomly received intravenous nalbuphine 0.05 mg/kg(Group 1; n=20), 0.1 mg/kg(Group 2; n=20) or 0.15 mg/kg(Group 3; n=20). The severity of nausea, vomiting, pruritus, degree of pain, sedation and vital sign were assessed prior to and 30 min after each dose. Results : The severity of nausea, vomiting and pruritus decreased significantly in all groups(p<0.01). Pain and sedation scores were unchanged in all groups. One patient received nalbuphine 0.15 mg/kg, complained of dizziness, agitation and palpitation. His blood pressure who had increased to 170/100 after first dose. Conclusions : This study suggests that intravenous nalbuphine is good for treatment of side effects following epidural morphine, and the dose of Group 1, 0.05 mg/kg, may be recommended as an optimal dose.

• The Korean Journal of Pain
• /
• v.10 no.2
• /
• pp.196-202
• /
• 1997

Background: Various pain treatments have been administered to relieve patients suffering from postoperative pain. Among these, epidural or intravenous opiate administration is by far the most widly applied treatment in recent times. However it was our objective to device a more effective and safe means of postoperative analgesia. Methods: We studied 110 healthy pregnant women scheduled for delivery by elective cesarean section. EPI(epidural)-group is administered morphine 1.5 mg and 0.25% bupivacaine 8 ml as bolus dose, then, a mixture of morphine 6 mg and 0.125% bupivacaine 95 ml as continuous dose via epidural route. IV(intravenous)-group is administered nalbuphine 6~7 mg as bolus dose and nalbuphine 60~70 mg with 0.9% normal saline 90 ml as continuous dose via intravenous route, at the rate of 2 ml/hr for 2 days. We compared the analgesic efficacy and side effects of these two groups using VAS pain score and time duration of constant pain level. Results: VAS pain score was similar between the two groups, but pain duration was significantly shorter in EPI-group. Incidence of pruritus was significantly lower with the IV-group, of nausea and vomiting were similar for both groups, no respiratory depression for either groups. Conclusions: Although the EPI-group had better analgesic efficacy, the IV-group had lower incidence of side effects, and simplicity and safety methods of operation. Therefore, We propose further research and consideration of administering the kinds and doses of those medications prescribe to the IV group in conjunction with other drugs for safer and better efficacy of postoperative analgesia.