Pain management of nalbuphine and sufentanil in patients admitted intensive care unit of different ages

Abstract

Background: Pain relief for patients in the intensive care unit (ICU) can improve treatment outcomes and reduce the burden on doctors and nurses. This study aims to report the clinical analgesic and sedative effects of nalbuphine and sufentanil on ICU patients.

Methods: This study retrospectively analyzed the medical records of 87 critically ill patients who received nalbuphine or sufentanil infusion in the ICU, including demographic data, diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II, Critical Care Pain Observation Tool (CPOT), Richmond Agitation-Sedation Scale (RASS), systolic and diastolic blood pressure, heart rate and blood oxygen saturation (SpO₂). The primary outcomes of this study were CPOT and RASS scores. The secondary outcomes were hemodynamic changes, including systolic blood pressure, diastolic blood pressure, heart rate, and SpO2. The adverse events recorded during pain management, such as hypoxemia, respiration depression and bradycardia, were also collected and analyzed.

Results: None of the patients in both groups experienced episode of hypoxemia, respiration depression and bradycardia. However, age-stratified analyses showed that nalbuphine has a better analgesic effect than sufentanil for patients aged ≤ 60 (P < 0.05). In contrast, sufentanil showed a better analgesic effect than nalbuphine for patients aged > 60 ( P < 0.05). Furthermore, nalbuphine has a significantly better sedative effect than sufentanil for patients aged ≤ 60 (P < 0.05).

Conclusion: ICU patients of different age groups may be suitable for different analgesics. For patients under the age of 60, nalbuphine has better analgesia and sedation than sufentanil, and does not cause respiratory depression and drastic hemodynamic changes.

Keywords: Analgesia; Intensive care unit; Nalbuphine; Sedation; Sufentanil.

Fig. 1

Patients features in the ICU during nalbuphine or sufentanil infusion. (A) Pain intensity in ICU patients receiving nalbuphine or sufentanil at different time points (mean ± SD). Pain intensity was evaluated by CPOT. There was no significant difference between groups (GEE, P > 0.05). (B) Sedation/restlessness intensity in ICU patients receiving nalbuphine or sufentanil at different time points. Sedation/restlessness intensity was evaluated by RASS. Nalbuphine showed a better sedative effect than that of sufentanil (GEE, P = 0.037) (C) Heart rate of ICU patients at different time points during nalbuphine or sufentanil infusion. There was no significant difference between groups (GEE, P > 0.05). (D) SpO2 of ICU patients at different time points during nalbuphine or sufentanil infusion. No significant difference was observed between groups (GEE, P > 0.05). (E) SBP and (F) DBP of ICU patients receiving nalbuphine or sufentanil at different time points. Data were expressed as mean ± SD. The P-value was calculated using the generalized estimating equation method. Abbreviation: CPOT Critical Care Pain Observation Tool, RASS Richmond Agitation-Sedation Scale, SpO₂ oxygen saturation, SBP systolic blood pressure, DBP diastolic blood pressure

Fig. 2

Age-stratified analyses of the analgesic and sedative effects of sufentanil and nalbuphine on ICU patients. Pain intensity in ICU patients who received nalbuphine or sufentanil at different time points under 60 (A) and over 60 years of age (B). Sedation/restlessness intensity in ICU patients who received nalbuphine or sufentanil at different time points under 60 (C) and over 60 years of age (D). Data were expressed as mean ± SD. The P-value was calculated using the generalized estimating equation method. The asterisk indicates that there is a significant difference between the groups at the specified time point