Alghamdi Mohannad, Almulhim Mohamed, Almulihi Qasem, Alhamaid Yousef A, Assiri Mohammad, Alzahid Abdullah, Al Ghanim Basmah, Albaish Lama, Alkhunaizi Lama, Alali Shahad, Alshehri Layan
Department of Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Dammam, Saudi Arabia.
College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Saudi J Med Med Sci. 2025 Jul-Sep;13(3):181-188. doi: 10.4103/sjmms.sjmms_601_24. Epub 2025 Jul 14.
The use of morphine in managing vaso-occlusive crisis (VOC) in patients with sickle cell disease (SCD) can result in significant side effects. Nalbuphine, a mixed agonist-antagonist opioid, may offer an alternative with fewer complications.
To compare the efficacy and safety of nalbuphine and morphine in pain management among adult SCD patients presenting with VOC.
This retrospective study included adult patients with SCD treated at King Fahad Hospital, Hofuf, Saudi Arabia, between 2019 and 2023. Patients were classified into two groups (receiving morphine and nalbuphine). Pain levels were assessed using the Visual Analog Scale (VAS) at baseline, 1-h, 6-h, and 24-h post-administration. Additional outcomes included the need for rescue medication and discharge rates from the emergency department.
A total of 234 patients were included (morphine: 120; nalbuphine: 114). The mean age of the cohort was 30.5 ± 8.7 years, and 63.8% were female. Baseline laboratory data indicated mean hemoglobin of 8.5 g/dL and elevated lactate dehydrogenase (576.9 U/L). At 6 h, 10% and 20% of patients on morphine and nalbuphine, respectively, reported no pain ( = 0.013). At 24 h, 30% and 40% of patients on nalbuphine and 15% and 25% on morphine experienced no pain and mild pain, respectively ( = 0.00002). Nalbuphine patients required less rescue medication (41% vs. 59%, = 0.009) and had higher discharge rates from the emergency department (70% vs. 46%, = 0.0003). No significant difference was found in the incidence of acute chest syndrome or ICU admissions between the two groups.
Nalbuphine can be a potential alternative for vaso-occlusive crisis pain management in sickle cell disease patients, as it demonstrated superior efficacy compared with morphine, especially at later time points, with reduced need for rescue medication and earlier discharge.
在镰状细胞病（SCD）患者中使用吗啡治疗血管阻塞性危机（VOC）可能会导致显著的副作用。纳布啡，一种混合激动剂-拮抗剂阿片类药物，可能是一种并发症较少的替代选择。
比较纳布啡和吗啡在患有VOC的成年SCD患者疼痛管理中的疗效和安全性。
这项回顾性研究纳入了2019年至2023年期间在沙特阿拉伯胡富夫法赫德国王医院接受治疗的成年SCD患者。患者被分为两组（接受吗啡和纳布啡）。在给药后基线、1小时、6小时和24小时使用视觉模拟量表（VAS）评估疼痛程度。其他结果包括是否需要急救药物以及急诊科的出院率。
共纳入234例患者（吗啡组：120例；纳布啡组：114例）。该队列的平均年龄为30.5±8.7岁，63.8%为女性。基线实验室数据显示平均血红蛋白为8.5 g/dL，乳酸脱氢酶升高（576.9 U/L）。在6小时时，分别有10%和20%使用吗啡和纳布啡的患者报告无疼痛（P = 0.013）。在24小时时，使用纳布啡的患者中分别有30%和40%、使用吗啡的患者中分别有15%和25%无疼痛和轻度疼痛（P = 0.00002）。纳布啡组患者需要的急救药物较少（41%对59%，P = 0.009），且急诊科出院率较高（70%对46%，P = 0.0003）。两组之间急性胸部综合征的发生率或入住重症监护病房的情况无显著差异。
纳布啡可能是镰状细胞病患者血管阻塞性危机疼痛管理的一种潜在替代药物，因为与吗啡相比，它显示出更好的疗效，尤其是在后期时间点，需要的急救药物减少，出院更早。
