title: Hitting them where it hurts? Low dose nalbuphine therapy.
abstract: OBJECTIVE
  To determine if low dose nalbuphine provides an adequate reduction in pain with minimal side effects.
  
  
  METHODS
  Prospective cohort of 115 patients given nalbuphine by paramedics in Wales and the English borders.
  
  
  METHODS
  (1) Mean total dose of nalbuphine administered, change in pain score, time to adequate pain relief (score below four), and change in respiratory rate and systolic blood pressure; (2) proportion of patients continuing to suffer moderate to severe pain on arrival at hospital; (3) incidence of adverse events.
  
  
  RESULTS
  Full data were obtained for all patients. The mean total dose of nalbuphine administered was 6.09 mg (range 2.5 to 12.5 mg). This was significantly higher in trauma than ischaemic chest pain patients (7.03 versus 5.13 mg). The mean reduction in pain score was -3.97 (95% CI -4.38 to -3.57, p<0.001). The mean time to adequate pain relief (where this was achieved) was 15.7 minutes (95% CI 13.4 to 17.9 minutes). On arrival at hospital 60% of patients (n=69, 95% CI 50.9 to 68.5%) still met ambulance criteria for analgesia (70.7% of trauma patients and 49.1% with ischaemic chest pain). Systolic blood pressure fell by a mean of -3.67 (95% CI -6.76 to -0.58, p=0.02) and respiratory rate increased by a mean of 1.63 (95% CI 1.08 to 2.17, p<0.001). Two patients complained of nausea (1.74%, 95% CI 0.5 to 6.0%). No other adverse events were reported.
  
  
  CONCLUSIONS
  Low dose nalbuphine results in few adverse events, but offers poor pain control for a high proportion of patients.
authors.affiliation: Pre-hospital Emergency Research Unit, Welsh Ambulance Services NHS Trust/University of Wales College of Medicine, Cardiff, UK . Malcolm.woollard@emergency-research.co.uk
authors.forename: M
authors.initials: M
authors.lastname: Woollard
authors.forename: T
authors.initials: T
authors.lastname: Jones
authors.forename: K
authors.initials: K
authors.lastname: Pitt
authors.forename: N
authors.initials: N
authors.lastname: Vetter
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002985:Clinical Protocols; D015331:Cohort Studies; D004632:Emergency Medical Services; D006801:Humans; D008485:Medical Audit; D009266:Nalbuphine / Q000008:administration & dosage*; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D009266:Nalbuphine