[HollymedicRN]

Hey there! I work in an interventional Cardiac unit where we regularly pull arterial lines post caths, and Nubain is frequently ordered for the line pull. However, I've had a couple of bad experiences with Nubain in pts that have been on a pain med at home for a long time; ie: Darvocet, Percocet, etc. where after I give the Nubain the pt goes absolutely nuts, acting very restless, c/o shaking and tingling feeling. We were told by a cardiac cath lab nurse that this was because Nubain competes for the pain receptor with the pain med and takes its place, effectively detoxing the pt very quickly. Has anyone come across this problem or heard about any research done on it? Thanks for reading!

[HollymedicRN]

Nobody has come across this at all? Huh.

[Spatialized]

It's not surprising. Nubain is an opioid agonist/atagonist (chemically related to Narcan by the way), so it does knock the other opioids off the receptors putting them into a near rapid-detox - probably not pleasant. Not to mention not good when you're trying to pull a sheath

It's a strange order though. It's kind of a weird old-skool choice...we had a doc in Flagstaff that loved to prescribe it, but haven't run across it here in Portland.

Cheers,
Tom

[HollymedicRN]

Yeah, it's only a couple docs that order it, most of them order Morphine. I've become so wary of Nubain during line pulls that I would rather use nothing at all. Which most patients really do fine with. The one time I gave it and was about to pull, we had just cut the stitch out of the art line when she started going nuts! Took 5 of us to hold this little old 70 something year old lady down for almost 2 hours while the nubain wore off. Jeez.

[vamedic4]

Originally Posted by HollymedicRN

Hey there! I work in an interventional Cardiac unit where we regularly pull arterial lines post caths, and Nubain is frequently ordered for the line pull. However, I've had a couple of bad experiences with Nubain in pts that have been on a pain med at home for a long time; ie: Darvocet, Percocet, etc. where after I give the Nubain the pt goes absolutely nuts, acting very restless, c/o shaking and tingling feeling. We were told by a cardiac cath lab nurse that this was because Nubain competes for the pain receptor with the pain med and takes its place, effectively detoxing the pt very quickly. Has anyone come across this problem or heard about any research done on it? Thanks for reading!

I can't believe no one recognized the symptoms and signs of narc withdrawal. Sounds like the doc should have paid better attention to the med history.

[angel110600]

I find everyone's answers very interesting. Nubain actually works on different opioid receptors. It works on the kappa and mu receptors and should actually provide a more powerful pain relief than others. It is actullay very effective for pain relief during post sheath removal. Is this medication ever mixed with Phenergan? If not, I highly recommend this because it provides a sedative effect as well.

This combination is often given to labor patients right before the transition phase. The effects usually wear off in a couple hours. I am sure in older patients the dosage should be cut in half, and for chronic pain patients, a higher dose is often needed.

[RN28MD]

I am sorry to sound dumb but what is removal sheath?

[dianah]

It's removal of a sheath, or arterial line, from an artery (or vein).

[Noryn]

As the above poster stated it will cause immediate withdrawal because it also has antagonistic properties. If someone is on an opiate then this should not be given.

[canoehead]

Funniest thing- I once had a patient on Q2h morphine and Q2h Nubain that got absolutely NO pain relief all night. She was labelled a drug seeker because of it. I did some research on the meds overnight and presented my theory to the day nurse in the AM who thought I was nuts. No doc would make a mistake that stupid ...NOT.

:banghead