J Korean Pain Soc.  1997 May;10(1):34-41.

Intravenous Patient - Controlled Analgesia with Nalbuphine: Could be an Altemative to Epidural Patient - Controlled Analgesia with Morphine - Bupivacaine for Pain Relief after Cesarean Delivery?

• Lee JS
• Lee YW
• Yoon DM
• Nam YT
• Song KH

Abstract

BACKGROUND
Patient-controlled analgesia (PCA) is a safe and effective technique for providing posto- perative pain relief. Studies that compare epidural vs intravenous routes of opiate administration show conflicting results. We designed a prospective, randomized, controlled study to evaluate the safety and efficacy of epidural (EPI-PCA) morphine-bupivacaine versus intravenous (IV-PCA) nalbuphine when administered with a PCA system.
METHODS
Forty healthy women were randomly assigned to receive an epidural bolus of morphine 3 mg and 0.5% bupivacaine 10 ml, followed by a EPI-PCA with 0.01% morphine and 0.143% bupiva- cane (basal infusion l ml/hr, bolus 1 ml, lock-out interval 30 min) or intravenous bolus of nalbuphine 0.1 mg/kg followed by a IV-PCA with nalbuphine (basal infusion 1 mg/hr, bolus 1 mg/1ml, lock-out interval 20 min) for pain relief after cesarean delivery. This study was conducted for 2 days after cesarean section to compare the analgesic efficacy, side effects, patient satisfaction either as EPI-PCA or as IV-PCA.
RESULTS
EPI-PCA group had significant lower visual analog pain scale (VAS) at immediate postop- erative period, whereas no significant difference was observed when pain was assessed at other time sequenee. Urinary retention and pruritus were more frequent with EPI-PCA group, although the incidence of other side effects were the same.
CONCLUSIONS
Although EPI-PCA with morphine-bupivacaine was of significantly lower VAS at immediate postoperative period, IV-PCA with nalbuphine is a safe and effective alternative to EPI-PCA with morphine-bupivacaine for providing pain relief after cesarean delivery. Further studies about IV-PCA with nalbuphine ate needed to control the immediate postoperative pain and to further improve effective pain management.

Keyword

Analgesia, patient-controlled (PCA), epidural, intravenous; Analgesics, morphine, nalbu- phine; Anesthetics, Local, bupivacaine; Pain, postoperative

MeSH Terms

Analgesia*
Analgesia, Patient-Controlled
Bupivacaine*
Canes
Cesarean Section
Female
Humans
Incidence
Morphine*
Nalbuphine*
Pain Management
Pain Measurement
Pain, Postoperative
Passive Cutaneous Anaphylaxis
Patient Satisfaction
Postoperative Period
Pregnancy
Prospective Studies
Pruritus
Urinary Retention
Bupivacaine
Morphine
Nalbuphine