13. Bain injection Established Clinical Profile
Nalbuphine HCl in Pain Management
Features Bain (nalbuphine HCl)
HCl) .
Indication Moderate to severe pain
Supplement to balanced anesthesia
Pre-op and post-op analgesia
Pre- post-
Obstetrical analgesia during labor and
delivery*
Route of Administration IM, IV, SC
Recommended Dose 5-10 mg (0.1 mg/kg; 10 mg/1 ml)
Onset of Action 2-3 minutes IV
Duration of Analgesia 3-6 hours (Plasma t1/2 = 5 hr)
Respiratory Depressant Effect “Ceiling Effect”7,8
Effect”
Cardiovascular Effect Slightly lowers cardiac workload 9-11
14. Bain injection
Nalbuphine HCl
Safety and Efficacy in a broad spectrum of
Clinical Settings:
Added Comfort to Patients
Recovery Room:
Rapid Return to Spontaneous Respiration and Full Consciousness
Adequate Post-operative Ventilation
Cardiovascular Stability
Very Low Incidence of Nausea/Vomiting
Shorter Stay in the Recovery Room
15. Bain injection
Nalbuphine HCl
Safety and Efficacy in a broad spectrum of
Clinical Settings:
Added Comfort to Patients
Post-Operative Setting:
Minimal Respiratory Depression Treatment for Morphine-induced Pruritus
Faster Onset and Long-acting Analgesia Treatment for Post-op Shivering
Lower Incidence of GI Distress Maintenance of Analgesia while Treating
A Very Low Incidence of Nausea/Vomiting Morphine-induced Adverse Effects
16. Bain injection
Nalbuphine HCl
• Safety and Efficacy in a Broad Spectrum of Clinical
Settings
Emergency Room*
• Rapid onset – within 2 to 3
minutes IV, less than 15
minutes IM or SC.
• Favorable haemodynamic
profile compared to that of
morphine.9
• Concomitant use may
produce an additive effect
with other narcotics,
tranquilizers, and
sedatives.
Reference: 9. Lee G, Low RI, Amsterdam EA, DeMaria AN, Huber PW, Mason DT. Haemodynamic effects of morphine and nalbuphine
in acute myocardial infarction. Clinical Pharmacology and Therapeutics. 1981;29(5):576-581.
*. Maintain patient under observation until recovered from Nubain effects. Nubain may impair mental or physical abilities
required for the performance of potentially dangerous tasks such as driving a car or operating machinery.
17. Reference (I) - Respiratory depression
• Clin Pharmacol Ther 1980 Apr; 27(4): 478-485
• Ceiling effect for respiratory depression by nalbuphine
• Narcotic antagonist analgesic: nalorphine (X), nalbuphine
- lower abuse liability
- ceiling effect for respiratory depression
- potency comparable to that of morphine
• Maximum respiratory depression occurred at 30 mg/70 kg.
• The ceiling effect for respiratory depression by
nalbuphine provides a unique safety factor among
potent analgesics.
18. Reference (II) - Gastrointestinal
• Br J Anaesth 1987; 59: 581-584
• Recovery of bowel motility after surgery
• Clinical indication of the return of coordinated bowel motility following
surgery is the passage of flatus
• Flatus: 5-80% CO 2
- Carbon dioxide analyzer to note the time to first flatus (TFF)
• Nalbuphine, Placebo (NS), morphine
• The median TFF:
- Bain vs. Placebo: 212 min: 64 min (3 times)
- IM Bain vs. morphine: 5.65 h: 11.84 h
• Nalbuphine will have considerably less adverse
effect on recovery of bowel function than morphine.
