1Departments of Pain Management and Palliative Medicine
2Department of Anesthesiology
3Departments of Obstetrics and Gynecology
4Department of Colorectal Surgery St. Martin de Porres Hospital, Chia-yi City, Taiwan, R.O.C.
Outline
Background
The aim of the study is to observe the clinical efficacy and safety of an agonist-antagonist opioid analgesic –nalbuphine sebacate, a new long-acting injectable pain killer, combined with parecoxib for post-surgical pain management.
Methods
We collected 10 patients who underwent surgical procedures and received nalbuphine sebacate 150 mg via deep intramuscular and Parecoxib 40 mg via intravenous injection postoperatively. We evaluated its analgesic efficacy and safety using a verbal ranking pain scale ( 0-10 ) at rest and during movement, a sedation scale by Ramsay Sedation Score ( 1-6 ), scales for mood state induced by pain ( 0-3 ), quality of sleep ( 0-3 ), and satisfaction ( 0-4 ) and adverse effects.
Data were collected in the post-anesthesia care unit, and in the general ward and at home 24, 48, 72 hours and 7 days after surgery.
Results
There was no interference with mood and sleep after injection of nalbuphine sebacate , and also no significant differences in the sedation scale during the recovery period and following days after surgery. All data showed statistically significant improvement in the pain score after treatment compared with the post-anesthesia recovery period in the recovery room ( p<0.05 ). Adverse effects included dizziness (50%), nausea (20%), vomiting (10%), and somnolence (10%), most of which improved after 2 to 3 days.
Conclusions
Nalbuphine sebacate combined with parecoxib was found to be effective in the treatment of post-surgical pain. Nalbuphine sebacate is an obviously potent analgesic, with a long duration of action, but with a slow onset of action and
limited adverse effects. However, we need more cases to prove these results in the future.
Nalbuphine Sebacate, Parecoxib, Post-surgical pain, Multi-model analgesia.
References
Bahar M, Rosen M, Vickers MD
Self-administered nalbuphine, morphine and pethidine - Comparison by intravenous route following cholecystectomy.
Anaesthesia. 1985; 40: 529-532.
Zeng Z, Lu J, Shu C, et al
A comparision of Nalbuphine with Morphine for analgesic effects and safety : Meta-analysis of randomized controlled trials.
Scientific Reports. 2015; 5:10927 DOI: 10.1 038/srep10927.
Pao LH, Hsiong CH, Hu OYP, et al.
In vitro and in vivo evaluation of the metabolism and pharmacokinetics of sebacoyl dinalbuphine.
Drug Metab Dispos Biol Fate Chem. 2005; 33:395-402.
Yeh CY, Jao SW, Chen JS, et al
Sebacoyl Dinalbuphine ester extended-release injection for long-acting analgesia - A multicenter, randomized, double-blind, and placebo-controlled study in hemorrhoidectomy patients.
Clin J Pain. 2017; 33: 429–434.
Wong JON, Tan TDM, Cheu NW, et al
Comparison of the efficacy of Parecoxib versus Ketorolac combined with Morphine on patientcontrolled analgesia for post-cesarean delivery pain management.
Acta Anaseth Taiwanica. 2010; 48: 174-177.
Feng YP, Huang NC, Chang HJ, et al
The role of epidural anesthesia plus ultrasound-guided peripheral nerve block and Naldebain in chronic post-surgical pain.
Taiwan J Pain. 2018; 28: 22-29.
Chou R, Gordon DB, de Leon-Casasola OA, et al
Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council.
J Pain. 2016; 17: 131-157.