Comparison of intravenous nalbuphine infusion versus saline as an adjuvant for epidural morphine

Jhi Joung Wang, Shung Tai Ho, Oliver Yoa Pu Hu

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13 Citations (Scopus)


Background and Objectives. Radical (three-quadrant) hemorrhoidectomy is a major anorectal surgery that may necessitate aggressive pain management. This study was undertaken to determine whether intravenous nalbuphine infusion as an adjuvant to epidural morphine could offer not only a good quality of pain relief but also a lower incidence of side effects. Methods. Sixty patients requiring epidural anesthesia for radical hemorrhoidectomy were enrolled in a randomized, double-blind study. At the end of the surgery, all patients received epidural morphine 4 mg for relief of postoperative pain. Thereafter, 2 mg and 3 mg of morphine were administered via the epidural route at 8 p.m. and 8 a.m., respectively, for a 48-hour observation period. Patients in group 1 received an adjuvant intravenous infusion of nalbuphine 15 μg/kg/h, whereas patients in group 2 received intravenous saline only. A rescue analgesic of intramuscular meperidine 40 mg (every 4 hours) was available for each patient. Results. All patients had adequate postoperative pain relief. Cumulative (48-hour) analgesic requirements were similar. During the 48-hour observation period, one patient in group 1 and six in group 2 demonstrated a PaCO2 above 45 mm Hg. No patient had an SaO2 below 90%. The incidence of nausea and/or vomiting was 13% in group 1 and 62% in group 2. The incidence of pruritus was 7% in group 1 and 62% in group 2. Conclusions. The results suggest that intravenous nalbuphine infusion as an adjuvant for epidural morphine reduces the incidence of side effects without decreasing the quality of pain relief.

Original languageEnglish
Pages (from-to)214-218
Number of pages5
JournalRegional Anesthesia
Issue number3
Publication statusPublished - May 29 1996
Externally publishedYes



  • analgesia
  • epidural
  • hemorrhoidectomy
  • morphine
  • nalbuphine

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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