Download full-text PDF. Medical Studies/Studia Medyczne ; 33/2. Review paper. Nalbuphine: some aspects of the research and. PDF | Background and Aim Nalbuphine as an adjuvant intrathecally can produce significant analgesia with minimal Download full-text PDF. NUBAIN (nalbuphine hydrochloride) is a synthetic opioid agonist-antagonist NUBAIN is available in two concentrations, 10 mg and 20 mg of nalbuphine.
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The introduction of nalbuphine to intravenous sedation with midazolam added little to There was a greater tendency for patients who received nalbuphine and . to Evaluate the Effects of Intrathecal Nalbuphine in Patients of Lower Abdominal Surgeries under. Spinal Anaesthesia. Pallavi Ahluwalia1, Amit Ahluwalia2. The agonist/antagonist analgesics, butorphanol (Stadol) and nalbuphine (Nubain ), are being increasingly employed as intravenous sedation agents;.
Sensitivity analyse and subgroup analysis could be conducted. Meta regression analysis by the stata statistical software version Tau-squared expresses remel estimate of between-study variance, and the smaller the value is, the better the goodness of fit of the model becomes. R-squared represents how much the covariate currently into the model can explain the amount of variation between the research. All P values reported are two-sided.
Discussion Overall, patients were included in the meta-analysis. This meta-analysis of randomized controlled trials provides the solid evidence to date regarding the efficacy and safety comparing nalbuphine with morphine.
We discovered nalbuphine was comparable to morphine regarding analgesic efficacy. As we know, the evaluation of incidence of pain relief we extracted was not the most direct evidence, which was weakly expressed in clinical evidence for clinical effects, and thus, could not do better than the direct evidence of pain scores for evaluation. Even so, the outcomes we provided were worth considering. In addition, study quality of included studies had been considered, and in general, none of the ten studies 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , which were made use of analyzing pain relief, was of low quality.
In addition to this, allocation concealment had been evaluated, 5 of 10 studies reported allocation concealment 7 , 8 , 9 , 10 , 15 , which thus could present a more comprehensive evaluation of the possible bias in a randomized controlled study. All studies eligible for analysis used a randomized controlled design, which improved the reliability of the evidence. The study by Etches et al.
In this study, 4 patients who received epidural nalbuphine 10 mg and all 5 who received epidural nalbuphine 20 mg got inadequate analgesia, and all 6 patients who received morphine had satisfactory analgesia morphine vs. If the study by Etches et al. The study by Baxter et al. Figure 1 shows the outcome of analgesic effects comparing nalbuphine with morphine, then we can find that the study by Minai et al. However, we can not ignore this research, for that its quality was all right.
Except for pain relief, there are many aspects to evaluate the effect of drugs, such as speed of drug action, efficacy of maintaining time, and pain scores. Culebras et al.
As we know, pruritus is the most frequent side effect associated with spinal morphine 26 that limits its use. This adverse effect is often difficult to treat and patients responds poorly to conventional treatments And The study by Somrat et al. This study demonstrated a Mixed agonist-antagonist opioid effects of nalbuphine have been reported for prevention of pruritus after epidural morphine 33 , 34 , 35 Duration of action of intravenous nalbuphine is shorter than the duration of epidural morphine induced pruritus, and continuous intravenous infusion is needed to treat this side effect Side effects such as pruritus, nausea, vomiting and urinary retention, are common 36 , but the most serious problem is respiratory depression Nalbuphine has a plateau effect on respiratory depression when given on its own It has been shown to reverse the respiratory depression from both intravenous 30 and epidural 31 opioids.
When comparing nalbuphine with morphine, the pooled RRs were 0. Nalbuphine suppressed cancer stem-like traits and EMT in both breast cancer cells and mouse xenograft tumor tissues.
Additionally, activation of AKT reversed the nalbuphine-induced inhibition of cancer stem-like properties, tumorigenesis and EMT. Conclusions Our results demonstrate a new role of nalbuphine in inhibiting cancer stem-like properties and EMT in addition to relieving pain, which suggests that nalbuphine may be effective in breast cancer treatment.
Background A large number of breast cancer patients suffer from cancer-related pains caused by surgery, tumor progression and bone metastasis [ 1 ]. Some previous studies [ 4 , 5 , 6 ] also proved that opioid analgesics could induce cancer metastasis, angiogenesis, and drug resistance. However, nalbuphine, a narcotic kappa receptor agonist and partial mu receptor antagonist, provides comparable analgesic efficacy to opioid analgesics [ 7 ] with fewer opioid-induced adverse effects [ 8 ].
It has been shown to be safe and effective when used for the treatment of conditions ranging from burns, multiple trauma, orthopedic injuries, gynecological and intra-abdominal conditions [ 9 , 10 ]. Although nalbuphine has been proven to be potent and reliable against acute and chronic pain, its influence on the stem-like traits and EMT of human breast cancer cells has not been elucidated.
Cancer stem cells CSCs are part of a cellular hierarchy, harboring stem cell-like properties of self-renewal combined with the potential for aberrant differentiation [ 11 , 12 ]. The presence of CSCs is closely associated with tumorigenesis [ 13 ] and drug resistance [ 14 ], and they are able to generate the heterogeneous lineages of cancer cells that comprise tumors. Our previous results demonstrated that morphine and fentanyl could promote the development of breast cancer cells with stem-like phenotypes [ 2 , 3 ], but little is known about the effect of nalbuphine on cancer stem-like properties.
The epithelial-mesenchymal transition EMT is a complex cellular program by which epithelial cells lose their epithelial features and are transformed into cells with a mesenchymal phenotype [ 15 ]. It is well known that EMT is associated with embryonic development and wound healing, but the phenotype is also inherent to tumor invasiveness and metastasis, as well as stemness [ 16 ]. Whether nalbuphine can affect EMT in breast cancer remains largely unknown.
Our findings suggest that nalbuphine may be a better choice for breast cancer pain treatment than traditional opioids.
Before use, the medium was completed with bovine pit extract BPE, Lonza at a final concentration of 0. For the limiting dilution assay, dissociated primary cells were seeded in well plates at densities of 2, 4, 8, 16, 32 and 64 cells per well. After 10 days, the percent of wells not containing spheres for each cell density was calculated and plotted against the cells per well and regression lines were plotted [ 23 ].
The control group of mice received an equal volume of PBS. For serial dilution assays, , , , and primary cells were subcutaneously injected in each dorsal flank. Tumor sizes were measured in perpendicular dimensions using calipers. The p-value was obtained by comparing the control and treatment groups at each time point. The protocol for experimental animals was approved by the Institutional Animal Care and Use Committee of Dalian Medical University and was in accordance with the national guidelines for the care and maintenance of laboratory animals.
Statistical analysis Each in vivo and in vitro experiment was performed in triplicate and repeated at least three times. Statistical analyses were performed with SPSS software version A p-value less than 0. See other materials and methods in Additional file 1 : Supplemental methods.
Results Nalbuphine selectively inhibits tumor cell proliferation Breast cancer cell lines were incubated with various concentrations of nalbuphine for 24, 48 and 72 h. These results were further confirmed by colony formation assay. The colony numbers up to 14 days were markedly decreased in a dose-dependent manner following nalbuphine treatment Fig.