BMJ  2004;328:1426 (12 June), doi:10.1136/bmj.328.7453.1426

Clinical review

Lesson of the week

Nalbuphine and slow release morphine

Jason Smith, specialist registrar1, Henry Guly, consultant1

1 Accident and Emergency Department, Derriford Hospital, Plymouth PL6 8DH

Correspondence to: J Smith jasonesmith@doctors.org.uk

The first 150 words of the full text of this article appear below.

Introduction

Prehospital analgesia should ideally give fast and safe relief from pain without adversely affecting the clinical course of patients. Nalbuphine is the intravenous analgesic for severe pain that is most widely used by ambulance services in the United Kingdom, but morphine has now been licensed for use by paramedics and is being introduced by a number of ambulance services. We present a case highlighting an important contraindication to the use of nalbuphine.

Case report

A 60 year old woman fell in her garden, injuring her right leg. She had a history of renal cell carcinoma with cerebral and bony metastases, and was taking 90 mg of slow release morphine tablets twice a day to control her pain. Ambulance paramedics diagnosed a fractured femur, and her prehospital care included giving her 30 mg of nalbuphine intravenously for analgesia. She became agitated, and on arrival in the emergency department she was unable to keep . . . [Full text of this article]

Discussion


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This article has been cited by other articles:

  • Lutz, J M, de Mello, W F (2007). Sedate with caution. Emerg. Med. J. 24: 69-69 [Full text]  
  • Hartree, C. (2005). Caution with nalbuphine in patients on long-term opioids. Palliat Med 19: 168-168  
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