Nalbuphine by PCA-pump for analgesia following hysterectomy: bolus application versus continuous infusion with bolus application

• Published in: European journal of pain 2001-06, Vol.5 (2), p.219-226
• Main Authors: Krenn, Herbert, Oczenski, Wolfgang, Jellinek, Helmuth, Krumpl-Ströher, Martha, Schweitzer, Ekkehard, Fitzgerald, Robert D.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analgesia, Patient-Controlled; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; diclofenac; Diclofenac - administration & dosage; Female; Humans; Hysterectomy; Infusion Pumps; Middle Aged; nalbuphine; Nalbuphine - administration & dosage; Nalbuphine - adverse effects; nalbuphine, patient-controlled analgesia, postoperative pain, hysterectomy, diclofenac; Pain, Postoperative - drug therapy; patient-controlled analgesia; postoperative pain; Prospective Studies; Pulse Therapy, Drug; Single-Blind Method
• ISSN: 1090-3801; 1532-2149
• DOI: 10.1053/eujp.2001.0238

The analgesic properties of the partial agonist–antagonist nalbuphine in the postoperative period are well known. When used for patient-controlled analgesia (PCA) the effectiveness of this substance is comparable to that of morphine or tramadol. However, the optimal programme for administration of nalbuphine in PCA-pumps has not been investigated. In particular, the combination of bolus administration vs bolus administration plus continuous basal administration is disputable. We hypothesized that the administration of an extra basal rate of nalbuphine in addition to the patient- triggered bolus administration and supplemental doses of diclofenac when required, would lead to a significant improvement in analgesia, without affecting the differences in vital signs and side effects. After approvement by the institutional ethics committee, 50 female patients (ASA I or II) scheduled for elective hysterectomy were included in a prospective, single-blinded study and randomized either into bolus-continous (BC-)group (3 mg base rate/h, 1 mg bolus, 20 min lock out) or bolus (B-)group (no base rate, 1 mg bolus, 10 min lock out). During the observation period (up to 24 h postoperative) vital parameters, extent of analgesia (10-step VAS), and vigilance (5-step scale) were registered. Groups were compared by using unpaired Student t-test. Ap