Abstract
ObjectivesNalbuphine is as effective as morphine as a perioperative analgesic but has not been compared directly with sufentanil in clinical trials. The aims of this study were to compare the efficacy and safety of nalbuphine with that of sufentanil in patients undergoing colonoscopy and to determine the optimal doses of nalbuphine in this indication.MethodsTwo hundred and forty consecutive eligible patients aged 18–65 years with an American Society of Anesthesiologists classification of I–II and scheduled for colonoscopy were randomly allocated to receive sufentanil 0.1 μg/kg (group S), nalbuphine 0.1 mg/kg (group N1), nalbuphine 0.15 mg/kg (group N2), or nalbuphine 0.2 mg/kg (group N3). Baseline vital signs were recorded before the procedure. The four groups were monitored for propofol sedation using the bispectral index, and pain relief was assessed using the Visual Analog Scale and the modified Behavioral Pain Scale for non-intubated patients. The incidences of respiratory depression during endoscopy, nausea, vomiting, drowsiness, and abdominal distention were recorded in the post anesthesia care unit and in the first and second 24-hour periods after colonoscopy.ResultsThere was no significant difference in analgesia between the sufentanil group and the nalbuphine groups (p>0.05). Respiratory depression was significantly more common in group S than in groups N1 and N2 (p<0.05). The incidence of nausea was significantly higher in the nalbuphine groups than in the sufentanil group in the first 24 hours after colonoscopy (p<0.05).ConclusionsNalbuphine can be considered as a reasonable alternative to sufentanil in patients undergoing colonoscopy. Doses in the range of 0.1–0.2 mg/kg are recommended. The decreased risks of respiratory depression and apnea make nalbuphine suitable for patients with respiratory problems.
Highlights
Colonoscopy is considered the “gold standard” for diagnosing pathologies of the colon and rectum, and is the primary modality used to screen for colorectal cancer [1]
There was no significant difference in analgesia between the sufentanil group and the nalbuphine groups (p>0.05)
Nalbuphine can be considered as a reasonable alternative to sufentanil in patients undergoing colonoscopy
Summary
Colonoscopy is considered the “gold standard” for diagnosing pathologies of the colon and rectum, and is the primary modality used to screen for colorectal cancer [1]. Colonoscopy involves air insufflation and insertion of instruments, is generally perceived by patients as painful, and is poorly tolerated without sedation [2]. Sedation and analgesia are widely accepted by patients and considered by many gastroenterologists as an integral component of the endoscopic examination. Nalbuphine hydrochloride is a mixed agonist-antagonist opioid with a duration of action of approximately 3–6 hours. It is chemically related to both the agonist analgesic oxymorphone and the antagonist naloxone, and acts as an antagonist at the μ receptor and as an agonist at the κ receptor, resulting in analgesia and sedation with minimal effects in the cardiovascular system [3]. Other proposed advantages of nalbuphine as an agonist-antagonist opioid include a lower incidence of side effects (e.g., nausea and vomiting) than that with other opioid analgesics [5]. Nalbuphine is superior in treating opioid-induced pruritus without affecting analgesia [6]
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