Pain management with nubain

[nkochrn, RN]

I attended a class on pain management. According to the instructor nubain blocks opiate receptors and if morphine is given afterwards its not completely effective.

I plan to talk to the hospital pharmacist about this to get more info and do some research. I know our CRNA tends to use nubain and the surgeon then orders morphine for recovery.

In my own personal experience I had a lap chole and I'm not sure if I was given nubain. I did get morphine in recovery though and felt very little effect from it. I've never had morphine other than that one time to compare it to anything.

[nkochrn, RN]

I realize they use the morphine b\c of the stronger effect. Our surgeons almost always use morphine post op. I don't see any benefit to using morphine post op though if if the patient has already been given morphine b\c it doesn't seem it will be effective. I'm wondering if itd be better to use the nubain post op instead?

[Whispera, MSN, RN]

Morphine is very effective and the dosage can be titrated. If it wasn't effective, was it because the dosage wasn't high enough?

[nkochrn, RN]

I'm not trying 2 say its not effective when used alone but in combination with nubain its less effective.

[subee, MSN, CRNA]

Wow, I must be a real hick. 30 years of giving anesthesia and I've NEVER heard of using nubain. Never seen it in an OR; never heard of it at a conference; never saw it mentioned in an article. Work in a tertiary medical center.

[nkochrn, RN]

I guess I should have worded it differently. If surgery is recovering the patients then they usually get nubain 4 pain but then when they get 2 the floor we only have orders for morphines.

[wtbcrna, MSN, DNP, CRNA]

Nubain is opioid agonist-antagonist drug. It works by partially blocking/antagonizing the mu receptors and stimulates/has agonist activity on the kappa receptors. Nubain is mostly used due to its' ceiling effect and can reverse opioid induced respiratory depression, pruritus and reverse a spasms of the sphincter of oddi. Nubain will antagonize subsequent opioid administration, but can be overcome by increasing doses of opioids.

[CASTLEGATES]

Sounds like the NP doesn't have approval to prescribe higher scheduled drugs. BAD thing.

[elizabeth8503RN, MSN, EMT-B, NP]

I have had both morphine and nubane for migranes. Once for the morphine, once for the nubane. Neither worked for me. (I have long had issues with migranes, I have been hospitalized with migranes...had a morphine PCA, and been in the ER a few times and have usually had tordol for pain relief, which usually helps. One night I had a doctor who was a bit of an arrogant pain in the you know what, decided to give me nubain)

With morphine, I do not remember having any side effects, no nausea, no hallucinations, no issues what so ever, and this was with a PCA pump, which if I remember correctly, I did use at least a few times.

With the nubain, I had visual hallucinations, my hands became straw, (my fingers elongated, and everything around me seemed way way off). I already had the nausea, so I can't blame the nausea on the nubain.

Neither one of the medications helped the migrane, so I cannot say which was more effective, (and this was all for the exact same migrane....a migrane that lasted for 10 days....4 of which I was hospitalized for)

But that is just my worth....hope that helps....

Elizabeth