Nalbuphine versus Morphine as Part of Intravenous Anesthesia Post Cardiac Surgery

Hoda Shokri Ihab Ali

doi:10.4172/2155-6148.1000463

Abstract

Objectives: The analgesic properties of nalbuphine mixed agonist antagonist opioid, in the postoperative period are well known. Our prospective study aims to compare nalbuphine and morphine as intravenous anesthetics together with propofol infusion, in the early postoperative period, following cardiac surgery. Methods: 40 patients with ASA I-III schedueled for elective primary isolated coronary artery bypass grafting were included. Nalbuphine group (20 patients) received nalbuphine administrated by intravenous continuous infusion once arrived in cardiac intensive care unit. Morphine group (20 patients) received morphine by intravenous continuous infusion once arrived in cardiac intensive care unit. Changes in hemodynamic variables greater than 20% above or below the baseline, VAS and sedation score, receiving additional doses of analgesia and incidence of complications are all analysed in all patients. Results: Both groups are comparable in their baseline demographic and surgical characteristics. Blood pressure remained within 20% of baseline in the nalbuphine group whereas, rise in mean blood pressure and heart rate more than 20% of base line occurred in the morphine group. 30% of patients in the nalbuphine group required additional doses of anaglesia, compared to 70% of the morphine group. VAS and sedation score were significantly better in the nalbuphine group than the morphine group. Incidence of vomiting and pruritis were significantly higher in the morphine group compared to the nalbuphine group. Conclusion: We concluded that Nalbuphine provided better hemodynamic stability, effective postoperative pain relief, with fewer complications, compared to morphine in patients post cardiac surgery.

Highlights

Nalbuphine is a semi-synthetic opioid having strong analgesic effects because of its agonist effects on K opioid receptors in the central nervous system (CNS)
The patients were randomly allocated to two groups Nalbuphine group (20 patients) to receive nalbuphine in an initial dose of 10 mg administered over 30 sec followed by IV continuous infusion (5 mg/hr) started up on arrival at the ICU and Morphine group (20 patients) to receive initial dose (1-3 mg) followed by IV infusion at a rate of 2 mg/hr once arrived at the ICU
Demographic characteristics were similar between the nalbuphine and morphine groups

Summary

Introduction

Nalbuphine is a semi-synthetic opioid having strong analgesic effects because of its agonist effects on K opioid receptors in the central nervous system (CNS). It has been shown that nalbuphine is either equipotent with morphine or has near equipotence [1]. Inspite of its agonist effects on the μ2 opioid receptors, its administration is accompanied by sedation, urinary retention and disphoria[9]. Nalbuphine compared with morphine, shows lower incidence of vomiting as well. Its onset of action ranged from 5-10 min after its intravenous adminstration [3], and its duration of action is 3-6 hours [4]. Its onset of action is about 30-60 min after its intravenous administration and its duration of action is about 4-6 hours [5]

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Conclusion