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

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

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*

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*

BACKGROUND: Acute postoperative pain control in children is an essential component of postoperative care, particularly in daycare procedures. Giving patients continuous narcotic analgesics can be risky; however, a single dose may be sufficient. METHODS: This study used a prospective, randomized controlled design and was conducted at the Pediatric Surgery Unit, Services Hospital, Lahore. In total, 150 patients who underwent inguinal herniotomy (age range: 1–12 years) were randomly assigned to two groups: group A (nalbuphine) and group B (tramadol). Patients were given a single dose of either nalbuphine (0.2 mg/kg) or tramadol (2 mg/kg) immediately after surgery and pain was measured at 0, 1, 2, 4, and 8 h. RESULTS: The demographic characteristics were similar between the two groups. The mean pain score was lower in group A than in group B at 0 and 1 h (P < 0.05). However, at 4 h and 8 h, the pain scores in group A were still lower, but not significantly. In all, 9 patients (12.0%) required rescue analgesics in group A compared to 16 patients (21.3%) in group B (P = 0.051). The mean time for requirement of rescue analgesics was 6.5 ± 0.5 h in group A and 5.3 ± 1.7 h in group B (P = 0.06). CONCLUSIONS: A single dose of nalbuphine is sufficient, and superior to tramadol, for postoperative pain management in children who have undergone daycare procedures.
Analgesics ; Child* ; Hernia, Inguinal ; Humans ; Nalbuphine* ; Narcotics ; Pain, Postoperative* ; Postoperative Care ; Prospective Studies ; Tramadol*

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: 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

To compare the respiratory depressant effect of nalbuphine and morphine, six healthy male volunteers (mean age 26 yr) were given the nalbuphine at a dose of 0.15 mg/kg and morphine at a dose of 0.1 mg/kg intravenously, at intervals of 2 weeks in a double-blind laboratory study. Respiratory depression was monitored by ventilatory responses during CO2 rebreathing at 1 min, 30 min, 60 min and 90 min after injection. The displacement (mean intercept at Petco2 60 mmHg) and the slope of the linear relationship between minute ventilation with Petco2 were measured, There were no significant differences in the slope and the displacement of CO2 response curve between nalbuphine group and morphine group. Also, no significant differences in the slope and the displacement among 1 min, 30 min, 60 min and 90 min after injection of nalbuphine and morphine were noted. These findings demonstrate that the respiratory depressant effect of nalbuphine in similar to morphine at equianalgesic dose, and occurs within 10 min, and continues more than 90 min.
Healthy Volunteers* ; Humans ; Injections, Intravenous* ; Male ; Morphine* ; Nalbuphine* ; Respiratory Insufficiency ; Ventilation ; Volunteers

PURPOSE: The PerFix(R) plug is preformed as a Marlex mesh hernia plug, and consists of a fluted outer layer combined with an inner arrangement of eight mesh "petals." In contrast to hand-rolled hernia plugs, which can collapse on themselves, the PerFix(R) plug's petals maintain the device's open conelike shape. The fluted design allows the plug to more readily conform to the configuration of any indirect or direct defect. METHODS: Bewteen January 1996 and April 2000 126 conventional herniorrhaphies (C group: Bassini: 23, Shouldice: 15, McVay: 5, Lichtenstein: 83) were performed, and between May 2000 and April 2002, 124 PerFix(R) plug repairs (P group) were completed. The operation times, lengths of hospital stay, visual analogue pain scales, time of analgesics use, and complication and recurrence rates were compared between these two groups. RESULTS: The operation times and lengths of hospital stay for groups C and P were 56.4 vs. 31.1 minutes and 4.4 vs. 2.8 days, respectively, so where significantly shorter in the P group (P<0.01). The times of use for the analgesics, AAP and Nubaine, were 6.6 vs. 0.6 times and 1.7 vs. 0.9 times, in group C and P, respectively, so were significantly fewer in the P group (P<0.01). There were 5 recurrences (3.9%) in the C group during the follow up period (2~6 years), but there were none in the P group during the follow up period (5 months~2 years). The complications were similar in both groups. CONCLUSION: Compared with conventional surgical techniques, including the Lichtenstein tension free method, the PerFix(R) plug method is the most simple, and shows superiority in the following areas; the operation time, length of hospital stay, times of analgesics use and recurrence. However, with regard to the recurrence, longer follow up and observation periods are required.
Analgesics ; Follow-Up Studies ; Hernia ; Hernia, Inguinal ; Herniorrhaphy* ; Length of Stay ; Nalbuphine ; Pain Measurement ; Polypropylenes ; Recurrence