Background & Aims
Parenteral opioid shortages continue to affect health institutions across the United States, forcing clinicians to explore alternate agents. Nalbuphine, a mixed agonist-antagonist, represents a possible alternative opioid for use in the inpatient setting when other opioids are unavailable. Given nalbuphine’s unique mechanism, utilization has historically been limited to use in obstetrics settings. This study aimed to assess the clinical impact of widespread use of nalbuphine during a widespread parenteral opioid shortage.
Methods
This was a single-center retrospective chart review performed in patients admitted for any reason during the period of parenteral opioid shortage between January 2018 and June 2018. The primary outcome of average pain score during admission was evaluated between patients who received either IV nalbuphine between January 2018 and March 2018, and use of IV morphine between April 2018 and June 2018. Secondary outcomes included: required change in parenteral opioid during hospitalization, change in opioid dose, and opioid prescription at discharge.
Results
A total of 138 patients, 47 patients in the nalbuphine group and 91 in the morphine group, were included in analysis. Average pain score throughout admission was 3.97 and 4.13 in the nalbuphine and morphine group, respectively (p = 0.695). There was no statistically significant change amongst average pain control on day 1, day 2, or last day of admission between groups. Average pain severity scores were higher in opioid-tolerant patients who received nalbuphine when compared to opioid-naïve patients who received nalbuphine (p = 0.003), day 1 (p < 0.001), day 2 (p = 0.016), and last day pain (p = 0.007). No evidence of acute opioid withdrawal symptoms were noted in opioid-tolerant patients receiving nalbuphine. Additionally, no differences were observed between patients assigned male or female sex at birth.
Conclusions
There was no significant difference in reported pain scores between morphine and nalbuphine during the periods assessed in opioid-naive patients. Utilizing nalbuphine in opioid-tolerant patients provided less optimal pain control compared to nalbuphine use in opioid-naive patients. Nalbuphine may represent an under-appreciated first-line parenteral opioid when strong analgesia is required in the acute care setting.
References
1. Zeng, Z., Lu, J., Shu, C., Chen, Y., Guo, T., Wu, Q. P., Yao, S. L., & Yin, P. (2015). A comparison of nalbuphine with morphine for analgesic effects and safety: Meta-analysis of randomized controlled trials. Scientific Reports, 5. https://doi.org/10.1038/srep10927
2. Gress, K., Charipova, K., Jung, J. W., Kaye, A. D., Paladini, A., Varrassi, G., Viswanath, O., & Urits, I. (2020). A comprehensive review of partial opioid agonists for the treatment of chronic pain. In Best Practice and Research: Clinical Anesthesiology (Vol. 34, Issue 3, pp. 449–461). Bailliere Tindall Ltd. https://doi.org/10.1016/j.bpa.2020.06.003
Presenting Author
Christopher M. Herndon
Poster Authors
Topics
- Treatment/Management: Pharmacology: Opioid