Nalbuphine Is Better Than Naloxone for Treatment of Side Effects After Epidural Morphine

• Published in: Anesthesia and analgesia Vol. 75; no. 5; pp. 747 - 752
• Main Authors: Cohen, Sheila E., Ratner, Emily F., Kreitzman, Ted R., Archer, John H., Mignano, Linda R.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.11.1992; Lippincott
• Subjects: Adult; Analgesia, Epidural - adverse effects; Biological and medical sciences; Cesarean Section; Drug toxicity and drugs side effects treatment; Female; Humans; Medical sciences; Miscellaneous (drug allergy, mutagens, teratogens...); Morphine - adverse effects; Nalbuphine - adverse effects; Nalbuphine - therapeutic use; Naloxone - adverse effects; Naloxone - therapeutic use; Pain, Postoperative - drug therapy; Pharmacology. Drug treatments; Pregnancy; Human; Narcotic antagonist; Chemotherapy; Treatment; Toxicity; Morphine; Opiates; Narcotic analgesic
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/00000539-199211000-00016

This study compared naloxone and nalbuphine when administered for treatment of side effects after epidural morphine, 5 mg, given for postcesarean analgesia. Patients requesting treatment for pruritus or nausea randomly received, in a double-blind fashion, up to three intravenous doses of either naloxone 0.2 mg (group 1; n = 20) or nalbuphine 5 mg (group 2; n = 20). The incidence of vomiting, the severity of nausea and pruritus, and the degree of sedation and pain were assessed before and 30 min after each dose. The first dose of nalbuphine decreased the incidence of vomiting (P < 0.005) and the severity of nausea and pruritus (P < 0.01), whereas naloxone caused no significant changes. Sedation scores increased after nalbuphine (P < 0.05) and remained unchanged after naloxone, whereas pain scores increased after naloxone (P < 0.01) and were unchanged after nalbuphine. Eighteen patients in group 1 and 12 in group 2 received a second dose, and 8 and 4 patients, respectively, a third dose. Other than decreased pruritus after the second dose with both drugs, no further changes occurred. We conclude that nalbuphine is superior to naloxone for the treatment of side effects after epidural morphine. However, persistent symptoms may require supplemental therapy, as repeated doses proved less effective than the initial dose.