Obesity became an epidemic condition worldwide with a significant impact in healthcare and surgical interventions emerged as a treatment for it. Due to their health conditions, obese population are at higher risk of presenting opioids adverse effects. The goal of this study is to assess the potential use of nalbuphine on bariatric surgery according to its beneficial effect as an agonist-antagonist opioid.
A total of 93 medical records of consecutive patients were selected retrospectively at Santa Casa de Porto Alegre Hospital from January 2018 to January 2019. Patients were overall women, middle-aged, with obesity grade 3 and with stable comorbidities. Sleeve gastrectomy was the main surgery technique by laparoscopic approach. Anesthesia used was essentially TIVA, with Dipyrone and NSAIDS as the main adjuvants associated. The time to the first requirement of nalbuphine (TFRN) and total dose of nalbuphine in 24h (TDN24) had medians of 80 minutes and 20mg, respectively. Respiratory depression, urinary retention and pruritus were not found in any patients. The only data statistically significant was sex related TDN24, with men using almost twice larger median doses than women.
The analgesic properties and adverse effects profile look encouraging in this setting. The female prevalence is a relevant information considering the influence of gender in nalbuphine efficacy. We can see the agreement with this concept observing that the only statistically significant difference in all study was the total dose of nalbuphine in the first 24h postoperative, favoring females.
Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: A systematic review and meta-analysis. Surgery, 2007; 142(4): 621-35.
Sjöström L, et al. Effects of Bariatric Surgery on Mortality in Swedish Obese Subjects. N Engl J Med, 2007; 357: 741-52.
Tsai A, Schumann R. Morbid obesity and perioperative complications. Curr Opin Anesthesiol, 2016; 29:103–8.
DeMaria EJ, et al. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database. Surg Obes Relat Dis. 2010 Jul-Aug; 6(4): 347–55.
Baerdemaekera L & Margarson M. Best anaesthetic drug strategy for morbidly obese patients. Curr Opin Anesthesiol, 2016; 29: 119–28.
Soleimanpour H, et al. Anesthetic Considerations in Patients Undergoing Bariatric Surgery: A Review Article. Anesth Pain Med. 2017 Aug; 7(4): e57568.
Pieracci FM, Barie PS, Pomp A. Critical care of the bariatric patient. Crit Care Med, 2006 Jun; 34(6): 1796-804.
Helling TS, Willoughby TL, Maxfield DM, Ryan P. Determinants of the need for intensive care and prolonged mechanical ventilation in patients undergoing bariatric surgery. Obes Surg, 2004; 14(8): 1036-41
Cend JC, et al. Utilization of intensive care resources in bariatric surgery. Obes Surg, 2005; 15(9): 1247-51.
Juvin P, et al. Post-operative course after conventional or laparoscopic gastroplasty in morbidly obese patients. Eur J Anaesthesiol, 1999; 16(6): 400-3.
Poulose BK, et al. National analysis of adverse patient safety events in bariatric surgery. Am Surg, 2005; 71(5): 406-13.
Beaver WT, Feise GA. A comparison of the analgesic effect of intramuscular nalbuphine and morphine in patients with postoperative pain. J Pharmacol Exp Ther, 1978; 204: 487-96.
Mazak K. Physico-chemical profiling of semisynthetic opioids. Journal of Pharmaceutical and Biomedical Analysis, 2017; 135: 97–105.
Zacny JP, Conley K, Marks S. Comparing the subjective, psychomotor and physiological effects of intravenous nalbuphine and morphine in healthy volunteers. J Pharmacol Exp Ther, 1997; 280: 1159–69.
Gunion MW, Marchionne AM, Anderson CTM. Use of the mixed agonist-antagonist nalbuphine in opioid based analgesia. Acute Pain, 2004; 6: 29–39.
Mendes FF, et al. Is Nalbuphine a better option than morphine in post ambulatory videolaparascopic colecistectomy? Random double blind study. REV DOR 2004; 5(4): 389-94.
Zeng Z, et al. A Comparision of Nalbuphine with Morphine for Analgesic Effects and Safety: Meta-Analysis of Randomized Controlled Trials. Sci Rep 2015; 5:10927.
Oliveira ARD, Weston AC, Martinelli ES. May We Consider the Use of Nalbuphine as Postoperative Opioid in Bariatric Patients? J Anesth Crit Care Open Access, 2016; 4(5): 00159.
English WJ, et al. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis, 2020; 16(4): 457-63.
Minai FN, Khan FA. A comparison of morphine and nalbuphine for intraoperative and postoperative analgesia. J Pak Med Assoc, 2003; 53:391–96.
Chartoff EH, Mavrikaki M. Sex Differences in Kappa Opioid Receptor Function and Their Potential Impact on Addiction. Front Neurosci, 2015; 9: 466.
Culebras X, Gaggero G, Zatloukal J, Kern C, Marti RA. Advantages of intrathecal nalbuphine, compared with intrathecal morphine, after cesarean delivery: an evaluation of postoperative analgesia and adverse effects. Anesth Analg, 2000; 91: 601–5.
Pinnock CA, Bell A, Smith G. A comparison of nalbuphine and morphine as premedication agents for minor gynaecological surgery. Anaesthesia, 1985; 40: 1078–81.
Bahar M, Rosen M, Vickers MD. Self-administered nalbuphine, morphine and pethidine. Comparison, by intravenous route, following cholecystectomy. Anaesthesia, 1985; 40(6): 529-32.
Pugh GC, Drummond GB. A dose-response study with nalbuphine hydrochloride for pain in patients after upper abdominal surgery. Br Journal Anesthesiology, 1987; 59(11): 1356-63.
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