Abstract
The efficacy of nalbuphine, an agonistlantagonist opioid, in preventing respiratory depression from epidural morphine analgesia after thoracotomy, was assessed in a randomized double-blind placebo controlled trial. After a standardized general anaesthetic and 0.15 mg· kg− of epidural morphine, patients received a bolus and then a 24 h infusion of nalbuphine (200μg·kg−1 + 50μg·kg−1·−1, 100μg·kg−1 + 25μg·kg−1· hr−1, or 50 μg·kg−1 + 12.5μg·kg−1 ·hr−1) or placebo. Blood gases, analgesia, sedation, side effects, and blood nalbuphine concentrations were assessed every two hours for the next 24 h. Fifty-three per cent of placebo-treated patients had a PaCO2 > 50 mmHg and 89 per cent of these received naloxone. A 200 μg·kg−1 bolus of nalbuphine followed by a 50 μg · kg−1· hr−1infusion achieved a mean steady state blood level of 38.2 ng · ml−1 and prevented CO2 retention greater than 50 mmHg in all but two patients, neither of whom required naloxone. There was no difference in the incidence of side effects among groups, and analgesia appeared to be unaffected by nalbuphine.
Résumé
Une étude a doubte-insue et avec placebo a été faite pour évaluer la nalbuphine, un opioid agoniste-antagoniste, comme agent prophylactique de la dépression respiratoire subséquente à l’injection épidurale de morphine après une thoracotomie. Après une anesthésie générale uniformisée et une injection épidurale de 0.15 mg · kg−1 de morphine, un bolus suivi d’une infusion de nalbuphine ou placebo pendant 24 heures furent administrés aux patients (soit 200 μ·kg−1 + 50μg·kg−1 hr−1, ou 100μgkg−1 + 25μg·−1· hr−1, or 50μg·kg−1 + 12.5 μg·kg−1hr−1 ou un placebo). Lagazométrie, ranalgésie, la sédation, les effets secondaires, et les niveaux sanguins de nalbuphine furent évalués aux deux heures pendant 24 heures. Cinquante-trois pourcent des patients ayant reçu le placebo eurent un PaCO2 > 50 mmHg et 89% de ces patients eurent besoin de naloxone. Les patients ayant reçu un bolus de 200μg·kg−1 et une infusion de 50μg·kg−1·hr−1 eurent des concentrations sanguines stables de 38.2 ng·mt−1; de plus, aucun de ces patients n’eut besoin de naloxone et tous sauf deux eurent des PaCO2 < 50 mmHg. L’incidence des effets secondaires fut la méme dans tous les groupes el l’analgésie de base de ces patients ne fut pas modifiée par la nalbuphine.
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Baxter, A.D., Samson, B., Penning, J. et al. Prevention of epidural morphine-induced respiratory depression with intravenous nalbuphine infusion in post-thoracotomy patients. Can J Anaesth 36, 503–509 (1989). https://doi.org/10.1007/BF03005375
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DOI: https://doi.org/10.1007/BF03005375