Method: In this study, a modification of the Vauzelle method of wake up test was employed. A relatively new analgesic drug, nalbuphine Hydrochloride, was used in a balanced anesthetic technique, in searching for a better methid of anesthesia that will allow awakening and spinal cord monitoring during surgey. Results: All patients were sucessfully awakened and were able to move their feet on command in 2 to 5 minutes (mean = 3.3 min. ) after the surgeon requested for the test. All patients were breathing spontaneously after the muscle relaxant was partially reversed. None required naloxone for the procedure. No complications related to the test were noted, such as self- extubation nor excessive struggling that may jeopardize the rod fixation. There were no neurological complications in this series. Conclusion: The result of our study in 5 patients indicate that balanced anesthesia with nalbuphine hydrochloride can be recommended for intraoperative awakening to monitor spinal cord function during surgery. The rapid return of wakefulness effective analgesia, reduced blood loss, stable cardiovascular system and minimal respiratory depression, make it one of the anesthetics of choice for the special procedure.
Human ; SCOLIOSIS ; NALBUPHINE ; ANESTHESIA

BACKGROUND: The effectiveness of preemptive analgesia is still controversial. This study was designed to compare the effects of nalbuphine used in the pre-anesthesia period and after surgery for pain control when performing adenoidectomy or tonsillectomy in children. METHODS: Two hundreds four patients (aged 3 to 12 years) were randomly allocated into two groups: the preemptive group (group P, n = 98) and the intraoperative group (group I, n = 106). Nalbuphine 0.1 mg/kg was administered into the patients before induction of anesthesia in group P and it was injected at least 10 minutes after the beginning of surgery in group I. The anesthesia was performed in the conventional fashion. The pain score, the sedation score and the agitation score were checked and recorded in the postanesthetic room (PAR) at arrival (0), at 15 minutes and at 30 minutes. RESULTS: The pain scores for PAR 0, 15 and 30 minutes were significantly lower in group I than those in group P. The other sedation scores or agitation scores were similar in both groups. CONCLUSIONS: Nalbuphine used during the pre-anesthetic period was less effective than that used in the intraoperative period for pain control when performing adenoidectomy or tonsillectomy in children.
Adenoidectomy ; Analgesia ; Anesthesia ; Child ; Dihydroergotamine ; Humans ; Intraoperative Period ; Nalbuphine ; Tonsillectomy

Nalbuphine, a mixed agonist-antagonist type opioid, can precipitate abstinence syndrome in opioid-dependent patients especially in large doses. We can prevent this syndrome by avoiding the injection of agonist-antagonist type opioid to the patient who already has used opioid for a long time, and the method of relatively small dose increments in its use. We experienced a case of opioid withdrawal symptom in chronically morphine-administered patient via epidural catheter after using intramuscular nalbuphine for analgesia. The symptom was promptly relieved by intravascular morphine injection without any problems.
Analgesia ; Catheters ; Humans ; Morphine ; Nalbuphine* ; Substance Withdrawal Syndrome*

This study was performed to compare the effects of epidural morphine and nalbuphine with general anesthesia for relief of pain after abdominal surgery. Patients were devided into three groups like Group I(General anesthesia), II(Epidural mor- phine) and III(Epidural nalbuphine). Pain score, gas passing and ambulation time were checked in all groups respectively. And side effects inclduing urinary retention and respiratory changes were evaluated too. The results were as follow. 1) The effects of epidural morphine and nalbuphine on pain relief were better than general anesthesia. And the effect of epidural morphine was superior to epidural nalbuphine too. 2) Ambulation time was the shortest in epidural morphine group. 3) Urinary retention, gas pasing time and respiratory changes were similar in a11 groups.
Anesthesia, General ; Humans ; Morphine* ; Nalbuphine* ; Urinary Retention ; Walking

BACKGROUND: The present study was performed to elicit what effect nalbuphine would have on isoflurane MAC (minimum alveolar concentration) in the patients undergoing lower abdominal surgery. METHODS: Sixty-two women were randomly allocated to one of five study groups to receive an intravenous injection of no nalbuphine (group I), 0.25 mg/kg (group II), 0.5 mg/kg (group III), 1.0 mg/kg (group IV), 1.5 mg/kg (group V). Anesthesia and tracheal intubation were induced with propofol 2 mg/kg, succinylcholine 1 mg/kg. Patients were inhaled at a preset end-tidal concentration of isoflurane, which was maintained for 20 min. Response to skin incision, movement or no movement, was determined 30 minutes after nalbuphine injection. The isoflurane concentration of the next patient in the same group moved up or down in steps of 0.1~0.3%, according to the previous patient's response. MAC was determined using the "up-down" method and logistic regression. RESULTS: The MAC's of isoflurane were 1.09 vol% end-tidal in the control group, 0.89 vol% in group II, 0.65 vol% in group III, 0.55 vol% in group IV, and 0.51 vol% in group V. CONCLUSIONS: It would be suggested that nalbuphine dose-dependently reduce the isoflurane MAC, and have ceiling effect on the reduction of isoflurane MAC.
Anesthesia ; Female ; Humans ; Injections, Intravenous ; Intubation ; Isoflurane* ; Logistic Models ; Nalbuphine* ; Propofol ; Skin ; Succinylcholine

BACKGROUND: This study was undertaken to reduce the side effects of epidural morphine through the addition of nalbuphine in 37 cesarean delivery. METHODS: Forty patients were divided into 2 groups; M(control) group: bolus administration of morphine 2 mg in 0.5% bupivacaine and continuous epidural 41 hour-infusion of morphine 7mg, N(experimental) group: bolus administration of morphine 2 mg in 0.5% bupivacaine combined with nalbuphine 10mg and continuous epidural 41 hour-infusion of morphine 7mg combined with nalbuphine 10mg via the Paragon infusor. RESULTS: During the postoperative 48 hours, their pain scores and side effects were recorded at 6, 12, 18, 24, 30, 36, 42 and 48 hours. The analgesic effects were good in two groups(mean VAS <3.0) and pain scores were statistically significant at 18 and 30 hour. The incidence of pruritus, nausea, vomiting and urinary retention was decreased in group N(p<0.05). CONCLUSIONS: We concluded that continuous epidural morphine combined with nalbuphine was one of recommendable methods to reduce side effects of morphine.
Bupivacaine ; Cesarean Section* ; Female ; Humans ; Incidence ; Infusion Pumps ; Morphine* ; Nalbuphine* ; Nausea ; Pregnancy ; Pruritus ; Urinary Retention ; Vomiting

BACKGROUND: Ketorolac is a potent anlagesic drug which has anti-inflammatory action and this drug may decrease the needed amount of opioids when used together with them for postoperative pain control. Preemptive analgesia with these drugs is still controversial. The analgesic effect and the presence of preemptive analgesia of a nalbuphine-ketorolac combination were examined in upper abdominal surgical patients. METHODS: Thirty patients undergoing elective upper abdominal surgery were randomly allocated into two groups. Each group received 10 mg of nalbuphine as a bolus dose just before starting IV-PCA which contained nalbuphine 70 mg and ketorolac 150 mg in 88 ml of 5% dextrose water. Group I (n=15) received drugs before starting the operation and group II received them at the end of the operation. The basal rate, PCA dose and lock-out interval were 1.5 ml, 1.5 ml and 10 minutes, respectively. In each group, the postoperative visual analogue scale (VAS) score, degree of satisfaction, total amount of drug used and side effects were checked and compared with corresponding figures in the other group for two postoperative days. RESULTS: Postoperative pain after upper abdominal surgery was controlled well in all patients and there were no significant differences in VAS scores between the two groups. Most patients were satisfied with this regimen. There were no remarkable side effects. Preemptive analgesia of nalbuphine-ketorolac combination was not found. CONCLUSIONS: IV-PCA administration of nalbuphine 70 mg and ketorolac 150 mg combination is an effective method to control postoperative pain in upper abdominal surgical patients. Preemptive analgesia is not found with this regimen.
Analgesia ; Analgesics, Opioid ; Glucose ; Humans ; Ketorolac ; Nalbuphine ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Water

BACKGROUND: The anesthesia machine PhysioFlex was especially constructed to deliver anesthetics in a closed circuit system. In this anesthesia machine the concentrations of the respiratory gases and the gas volume in the circle system are automatically controlled by a feedback mechanism. The aim of this study is to introduce 1,132 patients who have received general anesthesia in a closed circuit system using PhysioFlex, and to calculate the real consumed amount of oxygen and nitrous oxide, and to describe the advantages and disadvantages of PhysioFlex for clinical uses. METHOD: The author used a PhysioFlex in cases of 1,132 various surgical interventions. After induction with thiopentone and suxamethonium, general anesthesia was maintained with nitrous oxide in 50% oxygen and enflurane (or isoflurane, halothane) and supplemented with nalbuphine and pancuronium. These cases were analyzed by their sex, age, height, weight, method of airway maintenance during general anesthesia, operation position, anesthesia time, and arterial blood gases by review of anesthesia records. Average minute-consumed amount of oxygen and nitrous oxide was calculated by recording every 30 seconds throughout the anesthesia procedures except preoxygenation and flush periods. The advantages and disadvantages of PhysioFlex were described on the base of the author's clinical experience. RESULTS: The anesthetic technique of the closed circuit system by PhysioFlex could be used adequately for any surgical procedures. In this system consumed amounts of oxygen and nitrous oxide were 179.72+/-2.48 ml/min and 88.49+/-2.78 ml/min respectively. The author found out several advantages and few disadvantages of PhysioFlex for its clinical uses. CONCLUSIONS: Closed circuit system of PhysioFlex anesthesia machine offer numerous advantages such as reduction of gas consumption, low cost, less pollution in both the operating theater and the environment, increase in inspired gas humidity, easy handling of machine, and excellent respiratory alarm systems.
Anesthesia* ; Anesthesia, General ; Anesthetics ; Enflurane ; Gases ; Humans ; Humidity ; Isoflurane ; Nalbuphine ; Nitrous Oxide ; Oxygen ; Pancuronium ; Succinylcholine ; Thiopental

BACKGROUND: This study was performed to evaluate the effects of intercostal nerve block added in intravenous patient-controlled analgesia (IV-PCA; PCA) on pain, pulmonary function and the movement of the ipsilateral arm after a thoracotomy. METHODS: Forty five patients undergoing elective thoracotomy were randomly allocated into one of three groups. The groups were divided as follows: PCA, ICB-PCA (PCA and intercostal nerve blocks by direct injection of 5 ml of 0.2% bupivacaine into the intercostal spaces of two upper and two lower segments around the surgical incision) and IM groups. For the PCA, the patients that received PCA, were administered IV bolus of 0.1 mg/kg of nalbuphine followed by PCA with 0.1% nalbuphine (basal rate 0.5 ml/hr, bolus dose 1 mg and lockout interval 8 minutes). In each group, VAS score, the inspiratory capacity and the movement of the ipsilateral arm were checked postoperatively at 6, 24, 48 and 72 hours. RESULTS: Inspiratory capacity was decreased less in ICB-PCA group (P<0.05) at 6 hour, but after 24 hour, there were no differences between the groups. The analgesic effect was significantly better in ICB-PCA group as compared to the PCA or IM groups (P<0.05). Furthermore, arm motion limitation after operation was the least in ICB-PCA group (P<0.01). CONCLUSION: Intraoperative intercostal nerve blocks added in PCA has a transient improvement of pulmonary function, and also provide better analgesia and improved ipsilateral arm motion after a thoracotomy than in PCA or IM analgesia. The authors recommend adding intercostal nerve block for patients undergoing thoracotomy who receive IV-PCA.
Analgesia ; Analgesia, Patient-Controlled ; Arm ; Bupivacaine ; Humans ; Inspiratory Capacity* ; Intercostal Nerves* ; Nalbuphine ; Passive Cutaneous Anaphylaxis ; Thoracotomy*

A number of recent reports have described the usefulness of the epidural injection of narcotics for the relief of postoperative pain. But the epidural use of narcotic agonist-antagonist, nalbuphine hydrochloride, has not been reported. To study the effect of epidural nalbuphine hydrochloride for postoperative pain relief, we divided 73 patients into 5 groups randomly: 3 mg nalbuphine hydrochloride in 10 ml saline (group 1, n=9); 4 mg nalbuphine hydrochloride in 10 ml saline (group 2, n=14); 5 mg nalbuphine hydrochloride in 10 ml saline (group 3, n=21); 3 mg morphine in 10 ml saline (group 4, n=16); 4 mg morphine in 10 ml saline (group 5, n=13). The results were as follows 1) The onset time of analgesic effect were average 15~20 minitues in all groups 2) The durations of analgesia of epidural nalbuphine groups were (average; 5~7 hours) significantly shorter than morphine groups (average; 31~32 hours). 3) The degree of analgesia were same between 5 groups 4) The complications were nausea, vomiting and pruritus in all groups, but the frequency of pruritus in morphine groups was more than nalbuphine groups (p<0.05). 5) Urinary retention was observed only in morphine groups. In conclusion, the result of our study suggests that nalbuphine hydrochloride be better agent than morphine in terms of complication for postoperative pain relief but the duration of action is shorter than morphine, when injected epidurally.
Analgesia ; Humans ; Injections, Epidural ; Morphine ; Nalbuphine* ; Narcotics ; Nausea ; Pain, Postoperative* ; Pruritus ; Urinary Retention ; Vomiting