Multimodal Analgesia with Extended-Release Dinalbuphine Sebacate for Perioperative Pain Management in Upper Extremity Trauma Surgery: A Retrospective Comparative Study

Zhi-Hong Zheng; Tsu-Te Yeh; Chun-Chang Yeh; Po-An Lin; Chih-Shung Wong; Po-Yu Lee; Chueng-He Lu

doi:10.1007/s40122-022-00383-z

Multimodal Analgesia with Extended-Release Dinalbuphine Sebacate for Perioperative Pain Management in Upper Extremity Trauma Surgery: A Retrospective Comparative Study

Pain Ther. 2022 Jun;11(2):643-653. doi: 10.1007/s40122-022-00383-z. Epub 2022 Apr 15.

Authors

Zhi-Hong Zheng^{1

2}, Tsu-Te Yeh¹, Chun-Chang Yeh³, Po-An Lin³, Chih-Shung Wong⁴, Po-Yu Lee¹, Chueng-He Lu^{5

6}

Affiliations

¹ Department of Orthopedic Surgery, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan.
² Department of Orthopedic Surgery, Hualien Armed Forces General Hospital, Hualien, Taiwan.
³ Department of Anesthesiology, National Defense Medical Center, Tri-Service General Hospital, #325, Section 2, Chenggung Road, Neihu 114, Taipei, Taiwan.
⁴ Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan.
⁵ Department of Anesthesiology, National Defense Medical Center, Tri-Service General Hospital, #325, Section 2, Chenggung Road, Neihu 114, Taipei, Taiwan. box1971boy@yahoo.com.tw.
⁶ Centers for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. box1971boy@yahoo.com.tw.

Abstract

Introduction: Patients undergoing upper extremity fracture surgery (UEFS) commonly suffer from unbearable acute pain. Opioids remain the mainstay of moderate to severe pain alleviation, although there is a growing concern regarding the increasing trend in misuse and abuse. This study aimed to observe the safety and efficacy of dinalbuphine sebacate (DS), a novel extended-release analgesic, along with multimodal analgesia (MMA) for post-UEFS pain control.

Methods: We retrospectively reviewed the records of patients undergoing UEFS between August 2020 and January 2021. Eligible patients were included and divided into two groups, depending on the analgesic regimen. In the DS group, 150 mg DS was administered intramuscularly at least 12 h pre-operatively, while in the conventional analgesia (CA) group, 40 mg parecoxib was given within 3 h before surgery. Intraoperative fentanyl administration was guided by the Analgesia Nociception Index System in both groups. For breakthrough pain, fentanyl was used as rescue medicine in the postanaesthesia care unit while tramadol and parecoxib were administered in the ward.

Results: Forty-nine patients were allocated to the DS group and 60 patients were allocated to the CA group. In comparison with the CA group, the proportion of patients requiring opioids for breakthrough pain post-operatively was significantly lower in the DS group (fentanyl: 31% vs. 68%, p < 0.001; tramadol: 27% vs. 70%, p < 0.001). The DS group also consumed lower amounts of post-operative rescue opioids. Furthermore, both mean worst and least pain scores were significantly lower in the DS group from post-operative day (POD) 1 to POD 5. There was no significant difference in intraoperative consumption of fentanyl or incidence of adverse events.

Conclusion: This result suggests that extended-release DS is a suitable analgesic incorporated in MMA and a promising solution to the misuse and abuse of opioids.

Keywords: Dinalbuphine sebacate; Nalbuphine; Opioid analgesics; Post-operative pain; Tramadol; Upper extremity.