Excessive morphine requirements after pre-hospital nalbuphine analgesia

Nalbuphine hydrochloride is an opioid agonist-antagonist that has gained ac ceptance as a pre-hospital analgesic agent. Nalbuphine has equal analgesic properties to morphine, has a low addiction potential, and can be stored an d administered without restrictions, unlike morphine. To date no clinical e vidence has been published to support the theoretical difficulty that the a ction of opioids administered after nalbuphine could be altered or negated. The following case reports highlight 10 patients who received nalbuphine p re-hospital and subsequently required higher doses of opioid analgesia than expected. The discussion summarises the properties of nalbuphine and ident ifies potential reasons why excessive amounts of opioid analgesia were requ ired.