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  1. Jason Smith, specialist registrar (jasonesmith@doctors.org.uk)1,
  2. Henry Guly, consultant1
  1. 1Accident and Emergency Department, Derriford Hospital, Plymouth PL6 8DH
  1. Correspondence to: J Smith

    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 …

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