Nubain and Epidural Anesthesia, in case you didn't know

[DutchgirlRN, ASN, RN]

I made this mistake once and it was awful ! A friend of mine made the same mistake this week and again it was awful ! If you have a patient with an epidural post for pain do not give Nubain. It works like Narcan and patient goes into pain/agony. Our anesthesists always order it for break-thru pain but hey it doesn't work, just the opposite. I will never make that mistake again ! I understand it doesn't work like Narcan on everyone but on a large percentage and why take the chance. Has anyone else had this same experience?

[athomas91]

nubain is an opioid agonist/antagonist. it does help with pain relief by activating SOME of the pain receptors - however - it competitively inhibits narcotics by sitting in their receptors. therefore if someone is on any type of narcotic - it will inhibit that narcotic. nubain is an effective pain med when used by itself or with non-narcotic pain meds.

[DutchgirlRN, ASN, RN]

nubain is an opioid agonist/antagonist. it does help with pain relief by activating SOME of the pain receptors - however - it competitively inhibits narcotics by sitting in their receptors. therefore if someone is on any type of narcotic - it will inhibit that narcotic. nubain is an effective pain med when used by itself or with non-narcotic pain meds.

Why do they (anesthesioligists) always order it for break-thru pain on epidural patients? I don't see the rationale.

[athomas91]

it is fine for epidural patients if the epidural is just a type of local (marcaine...etc..) if there is an opioid in it (fent or duramorph) it is not a good idea.

[DutchgirlRN, ASN, RN]

Ours always have fent in them. Thanks for all the info !

[barefootlady, ADN, RN]

I was taught not to give Nubain to a patient on epidural narcs by anesthesia, we were instructed to call for a new order for break through pain med if Nubain was ordered in these cases. Like you said, it may not have that same effect on all patients, but the numbers are too high to take a chance. Thanks for jogging my memory. :balloons: