A prospective, randomized, double blind, comparative study of intramuscular nalbuphine hydrochloride, butorphanol tartrate and pentazocine lactate for post-operative pain relief following abdominal hysterectomy

Praveen P. V. V.S. B.; Vijaya Chandra Reddy Konda; Lohit K.

doi:10.18203/2319-2003.ijbcp20164049

Authors

Praveen P. V. V.S. B. Department of Drug Safety and Pharmacovigilance, Quintiles IMS (India) Private Limited, Bangalore, Karnataka, India
Vijaya Chandra Reddy Konda Department of Pharmacology, SVIMS, Sri Padmavathi Medical College for Women, Tirupati, Andhra Pradesh, India
Lohit K. Department of Pharmacology, Sri Siddhartha Medical College, Tumkur, Karnataka, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20164049

Keywords:

Analgesia, Butorphanol, Nalbuphine, Pentazocine, Surgery

Abstract

Background: This study aimed to compare the efficacy and safety of intramuscularly administered nalbuphine, butorphanol and pentazocine for post-operative pain relief after abdominal hysterectomy.

Methods: Seventy-five adult female patients, aged between 20-50 years, belonging to American Society of Anaesthesiologists (ASA) class 1 and 2, posted for abdominal hysterectomy under spinal anesthesia were included in the study. The subjects were randomly divided into 3 groups (n=25 each) and given – Group A: pentazocine lactate (30 mg, 1mL), Group B: butorphanol tartarate (2 mg, 1 ml) and Group C: nalbuphine hydrochloride (10 mg, 1 mL) when post-operative pain intensity reached ≥4 mm on the Visual analogue scale (VAS). The onset, duration, time to peak effect and adverse events were recorded at regular intervals for 24 hours, postoperatively.

Results: The mean time to onset of anesthesia was significantly faster (P<0.05 each) in the nalbuphine (10.2±2.2 minutes) and butorphanol (11.3±2 minutes) groups when compared to the pentazocine group (14±2.7 minutes). Duration of analgesic action was significantly longer (P<0.05 each) in the nalbuphine (236.4±75.1 minutes) and butorphanol (202±59.2 minutes) groups when compared to the pentazocine group (177.4±55.3 minutes). No significant differences in respiratory and cardiovascular parameters were noted between the groups. Nausea and vomiting was seen significantly higher in the pentazocine group (36%) when compared to butorphanol (20%) and nalbuphine (8%) groups (p<0.05 each).

Conclusions: Intramuscular nalbuphine and butorphanol provided effective analgesia with rapid onset and longer duration of action, with lower incidence of nausea and vomiting when compared to pentazocine. In particular, nalbuphine can be a suitable agent to provide post-operative pain relief in gynecologic lower abdominal surgery.

Metrics

Metrics Loading ...

References

Ramsay MA. Acute postoperative pain management. Proc (Bayl Univ Med Cent). 2000;13(3):244-47.

Venkateswaran R, Prasad KN. Management of postoperative pain. Indian J. Anaesth. 2006;50(5):345-54.

Misiołek H, Cettler M, Woroń J, Wordliczek J, Dobrogowski J, Mayzner-Zawadzka E. The 2014 guidelines for post-operative pain management. Anaesthesiology Intensive Therapy. 2014;46(4):221-44.

Garimella V, Cellini C. Postoperative Pain Control. Clin Colon Rectal Surg. 2013;26(3):191-96.

Bowdle TA. Adverse effects of opioid agonists and agonist-antagonists in anaesthesia. Drug Saf. 1998;19(3):173-89.

Hoskin PJ, Hanks GW. Opioid agonist-antagonist drugs in acute and chronic pain states. Drugs. 1991;41(3):326-44.

Massad IM, Mahafza TM, Abu-Halawah SA, Attyyat BA, Al-Ghanem SM, Almostafa MM, et al. Postoperative pain is undertreated: results from a local survey at Jordan University Hospital. East Mediterr Health J. 2013;19(5):485-9.

Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011;377(9784):2215-25.

Laska EM, Siegel C, Sunshine A. Onset and duration: measurement and analysis. Clin Pharmacol Ther. 1991;49:1-5.

North WC, Tielens DR. Comparison of butorphanol and pentazocine as postoperative analgesics. South Med J. 1979;72(5):578-80.

Lokeswari VV, Sarma AB, Madhusudhana DBVR. A Comparative Study of Intra Muscular Nalbuphine with Intra Muscular Butorphanol for the Relief of Postoperative Pain. IOSR Journal of Dental and Medical Sciences. 2015;14(8):122-27.

Dobkin AB, Eamkaow S, Caruso FS. Butorphanol and pentazocine in patients with severe postoperative pain. Clin Pharmacol Ther. 1975;18(5 Pt 1):547-53.

Bullingham RE, McQuay HJ, Moore RA. Clinical pharmacokinetics of narcotic agonist-antagonist drugs. Clin Pharmacokinet. 1983;8(4):332-43.

Hew E, Foster K, Gordon R, Hew-Sang E. A comparison of nalbuphine and meperidine in treatment of postoperative pain. Can J Anaesth. 1987;34(5):462-5.

Solanki RN, Gosai ND, Joshi GM, Patel BM, Modi HV , Jain R. A Comparative Study of Intravenous Nalbuphine HCl and Tramadol HCl for Post Operative Pain Relief Following Orthopaedic Surgeries. Asian Pac. J. Health Sci. 2015;2(1):155-60.

Zeng Z, Lu J, Shu C, Chen Y, Guo T, Wu QP, et al. A comparision of nalbuphine with morphine for analgesic effects and safety: meta-analysis of randomized controlled trials. Sci Rep. 2015;5:10927.

Palazzo MG, Strunin L. Anaesthesia and emesis: 1. Etiology, Can Anaesth Soc J. 1984;31:178-87.

Chung F, Mezei F. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg. 1999;89:1352-9.