Background: Inadequately treated postoperative pain can contribute significantly to morbidity in women undergoing cesarean section.  Recent studies showed that nalbuphine and fentanyl has promising result as neuraxial adjuvants in terms of postoperative analgesia and with lower incidents of adverse effect when use in cesarean section. 

Objective: To determine the effectiveness of postoperative analgesia with intrathecal nalbuphine versus intrathecal fentanyl as neuraxial adjuvants in cesarean section. 

Methods:  A meta-analysis following the PRISMA guidelines was performed.  Articles were searched through the Cochrane Library, PubMed.Gov and Pubmed Central, Google Scholar, HERDIN, WPRIM and ProQuest Guideline Central using different search strategies such as keywords and MeSH term.  Cochrane version 2 risk-of-bias tool for randomized trials (RoB 2) was used to assess for quality.  Quantitative data were pooled and analyzed using Review Manager 5.4. 

Results: A total of four trials, involving 425 full term pregnant women were analyzed. The pooled mean difference showed significantly longer duration of postoperative analgesia (MD=21.12 minutes, 95%CI=11.13,31.11, I2=73%), pooled risk ratio showed lesser risk for pruritus (RR=0.09, 95%CI=0.02,0.50, I2 = 0%) and postoperative nausea and vomiting (RR=0.38, 95%CI= 0.19,0.78, I2 = 11%) who received intrathecal nalbuphine compared to intrathecal fentanyl. 

Conclusions: The results of this meta-analysis demonstrates that the use of intrathecal nalbuphine appears to have a better outcome in increasing the duration of postoperative analgesia and with lesser incidence of PONV and pruritus than fentanyl.  However, due to the presence of heterogeneity it warrants that the results should be treated with caution especially with the possibility of publication bias. 

Recommendations: Better literature search through inclusion of high-quality studies from relevant databases and strict adherence on the uniformity of the dosage and methods used are very crucial to achieve the target clinical outcomes and minimize the publication bias. 

This study examined the sedative, analgesic, behavioral, and clinical effects of a combination of xylazine (XY) and nalbuphine-xylazine (NA-XY) in camels. A total of five adult camels were used in a prospective randomized cross-over design with a wash out period of two weeks. Camels were allocated randomly to two treatment groups: the XY group (xylazine, 1.1mL/100 kg IV) and the NA-XY group (xylazine, 1.1mL/100 kg IV and nalbuphine, 1 mg/kg IV). The sedative, analgesic, behavioral, and clinical effects of XY and NA-XY combination were evaluated prior to administration (baseline) and at 5, 15, 30, 45, 60, 75, 90, and 120 minutes post-administration. The results showed that the NA-XY combination accelerates the onset of sedation and analgesia and prolongs the durations of both sedation (p < 0.001) and analgesia (p < 0.01). The behavioral parameters showed higher scores with a NA-XY combination than xylazine alone. Although a XY injection resulted in a significant decline in the heart and respiratory rate, the NA-XY combination group revealed a non-significant change in both clinical parameters compared to the baseline. In conclusion, the use of a NA-XY combination in camels improved the sedative and analgesic onset and duration with an improved outcome in the behavioral scores, as well as in both the heart and respiratory rates compared to XY alone.
Adult ; Analgesia ; Camels ; Cross-Over Studies ; Heart ; Humans ; Nalbuphine ; Prospective Studies ; Respiratory Rate ; Xylazine

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: 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

BACKGROUND: The effect of epidural analgesia for labor on obstetric outcome is controversial. The purpose of this study is evaluating the influence of epidural analgesia on cesarean section in nulliparous women. METHODS: We retrospectively investigated 979 nulliparous women ASA graded I - II. EPI (n = 230) was received epidural analgesia with 0.2% ropivacaine and 75microgram fentanyl. N-EPI (n = 749) was received no epidural analgesia but nalbuphine 10 mg intramuscularly. We compared the rate and causes of cesarean section, instrumental delivery rate and fetal outcomes between EPI and N-EPI. RESULTS: Cesarean section rate was not different between the EPI (18%) and N-EPI (23%). Causes of cesarean section were progress failure (83% in EPI and 80% in N-EPI) and fetal distress (17% in EPI and 20% in N-EPI) and there were no differences between two groups. Instrumental delivery rate was higher in EPI (8%) than N-EPI (5%). Fetal outcome was not different between two groups. CONCLUSIONS: Epidural analgesia did not increase cesarean section rate and did not influence on causes of cesarean section. But epidural analgesia increased the vacuum delivery rate.
Amides ; Analgesia, Epidural ; Cesarean Section ; Female ; Fentanyl ; Fetal Distress ; Humans ; Nalbuphine ; Pregnancy ; Retrospective Studies ; Vacuum

BACKGROUND: Emergence agitation in children is frequently associated with sevoflurane general anesthesia. We measured the effects of propofol and nalbuphine on emergence agitation after sevoflurane anesthesia in children for strabismus surgery. METHODS: Ninety pediatric patients receiving sevoflurane anesthesia for elective strabismus surgery were enrolled. They were randomized to receive either saline (Group S), propofol 1 mg/kg (Group P), or nalbuphine 0.1 mg/kg (Group N) at the end of surgery. We evaluated the incidence of emergence agitation and recovery in the postanesthesia care unit. RESULTS: The time to recovery was similar between the three study groups. The incidence of agitation was significantly lower in Group N compared with Group S, but the incidence of agitation between Group S and Group P was not different. CONCLUSIONS: Nalbuphine 0.1 mg/kg at the end of strabismus surgery under sevoflurane anesthesia effectively reduced emergence agitation in children without delaying recovery, but propofol did not.
Anesthesia ; Anesthesia, General ; Child ; Dihydroergotamine ; Humans ; Incidence ; Methyl Ethers ; Nalbuphine ; Propofol ; Strabismus

BACKGROUND: Emergence agitation in children is frequently associated with sevoflurane general anesthesia. We measured the effects of propofol and nalbuphine on emergence agitation after sevoflurane anesthesia in children for strabismus surgery. METHODS: Ninety pediatric patients receiving sevoflurane anesthesia for elective strabismus surgery were enrolled. They were randomized to receive either saline (Group S), propofol 1 mg/kg (Group P), or nalbuphine 0.1 mg/kg (Group N) at the end of surgery. We evaluated the incidence of emergence agitation and recovery in the postanesthesia care unit. RESULTS: The time to recovery was similar between the three study groups. The incidence of agitation was significantly lower in Group N compared with Group S, but the incidence of agitation between Group S and Group P was not different. CONCLUSIONS: Nalbuphine 0.1 mg/kg at the end of strabismus surgery under sevoflurane anesthesia effectively reduced emergence agitation in children without delaying recovery, but propofol did not.
Anesthesia ; Anesthesia, General ; Child ; Dihydroergotamine ; Humans ; Incidence ; Methyl Ethers ; Nalbuphine ; Propofol ; Strabismus

BACKGROUND: Emergence agitation frequently occurs after desflurane anesthesia in children.Nalbuphine, because of its sedative and analgesic properties, might be useful for the management of this side effect.We studied the effect of nalbuphine on recovery characteristics and emergence agitation after desflurane anesthesia in children for strabismus surgery. METHODS: 41 patients (3-14 yr) scheduled for pediatric strabismus surgery were included.All children received ketamine 0.5 mg/kg intravenously before entering the operating room.After intravenous induction with thiopental and rocuronium to facilitate endotracheal intubation, patients were randomly assigned to receive saline, or nalbuphine 0.2 mg/kg respectively. Anesthesia was maintained with desflurane 4-6% with N2O : O2 = 2 : 1.At the end of anesthesia, time to cough, extubation, movement, eye opening and discharge were recorded.Emergence agitation was recorded by three point rating scale. RESULTS: Agitation scores were significantly different between the two groups (P < 0.01).Time to extubation and movement were similar between two groups.Time to eye opening was significantly increased in nalbuphine group (P < 0.05).But, there was no difference in time to discharge from the recovery room to the ward between the two groups. CONCLUSIONS: In children undergoing strabismus surgery with desflurane anesthesia, nalbuphine 0.2 mg/kg administered immediately after induction reduced incidence of emergence agitation without delaying discharge from recovery room.
Androstanols ; Anesthesia ; Child ; Cough ; Dihydroergotamine ; Eye ; Eye Movements ; Humans ; Incidence ; Intubation, Intratracheal ; Isoflurane ; Ketamine ; Nalbuphine ; Recovery Room ; Strabismus ; Thiopental

BACKGROUND: Remifentanil requires a long acting agent for postoperative pain control, and Nalbuphine, a long acting agonist-antagonist, causes less respiratory depression than pure mu-agonists. However, Nalbuphine can also cause additional distress when used with a pure mu-agonist. Therefore, we evaluated the effects of nalbuphine during TIVA with remifentanil and propofol. METHODS: 56 ASA class I, II adult patients undergoing minor surgery were included in this study. After maintaining BIS values between 40-60 as well as a relatively similar blood pressure (BP) and heart rate (HR) for 20 minutes without changing the target concentrations of anesthesia during surgical procedures, the subjects received either 0.1 ml/kg of normal saline or nalbuphine intravenously. Hemodynamic and BIS variables were then recorded for 20 minutes, during which time the target concentrations were not modified. The BIS values, heart rate, and mean arterial pressure were then compared between groups using t-tests, with a P < 0.05 being considered statistically significant. RESULTS: The mean BIS and HR measured at each interval in the nalbuphine group were not significantly different from those of the control group. However, 10, 15 and 20 minutes after the administration of nalbuphine, the mean systolic BP and the mean arterial BP of the treatment and control groups were significantly different (P < 0.05). In addition, the mean diastolic BP was also significantly different 10 and 20 minutes after the treatment was administered (P < 0.05). Postoperative pain was well controlled and none of the patients reported intraoperative awareness. CONCLUSIONS: Although nalbuphine seems to cause distress, which appeared as an increase in BP, it may still be used in combination with propofol and remifentanil because it did not cause a significant increase in the HR and BIS values.
Adult ; Anesthesia ; Anesthesia, Intravenous* ; Arterial Pressure ; Blood Pressure ; Heart Rate ; Hemodynamics ; Humans ; Intraoperative Awareness ; Nalbuphine* ; Pain, Postoperative ; Propofol* ; Respiratory Insufficiency ; Surgical Procedures, Minor

BACKGROUND: Since the mid-1990s, PerFix(R) plug hernioplasty has become one of the mainstays of hernia surgery. We previously reported the preliminary results of the PerFix(R) plug hernioplasty in 2003. Here we report the results of a 5 year follow-up study of PerFix(R) plug hernioplasty. METHODS: From May 2000 to April 2005, 326 PerFix(R) plug repairs were performed. The operation times, lengths of hospital stay, visual analogue pain scales, time of analgesics use and complications and recurrence rates were evaluated prospectively. RESULTS: 326 cases underwent mesh-plug hernioplasties, 285 with inguinal hernias primary, 35 with recurrent hernias and 6 with femoral hernias. 218 and 101 cases were indirect and direct hernias, respectively. The mean age was 59.8 years. The male to female ratio was 289 : 15. Cardiovascular disease is the most common associated disease. The mean operation time was 31 minutes. The mean length of hospital stay was 2.5 days. The mean length of analgesics use, acetaminophen (1T: 300 mg p.o) and Nubaine (5 mg IM), were 1.89 and 0.5, respectively. Seventy-six (23%) cases developed a postoperative complication with urinary retention being the most common. During the follow up period from 12 months to 6 years, the overall recurrence rate was 0.6% (n=2). CONCLUSIONS: Tension-free repair of an inguinal hernia by PerFix(R) plug is a simple and secure method with less pain, quick operation times, short hospital stays, low complication rates and low recurrence rates.
Acetaminophen ; Analgesics ; Cardiovascular Diseases ; Female ; Follow-Up Studies* ; Hernia ; Hernia, Femoral ; Hernia, Inguinal ; Herniorrhaphy* ; Humans ; Length of Stay ; Male ; Nalbuphine ; Pain Measurement ; Postoperative Complications ; Prospective Studies ; Recurrence ; Urinary Retention