Inpatient Nalbuphine Substitution During Intravenous IV Opioid Shortage for Acute Pain in a Community Hospital: A Retrospective Review

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Nalbuphine’s mixed agonist-antagonist activity has historically limited use. This study evaluated the impact of utilizing nalbuphine during admission during a parenteral opioid shortage. A single-center retrospective chart review was performed between January 2018 and June 2018 to compare outcomes between those who received nalbuphine and those who received morphine. The primary outcome was average pain score during admission. Secondary outcomes included: change in parenteral opioid, change in dose, and opioid prescription at discharge. In total, 138 patients, 47 in the nalbuphine group and 91 in the morphine group, were included. Average pain score during admission was 3.97 and 4.13 for nalbuphine and morphine, respectively (p = 0.695). There was no statistically significant change in average pain control on day 1, 2, or last day between groups. In opioid-tolerant patients who inadvertently received nalbuphine, average pain scores were higher compared to the nalbuphine opioid-naïve group, admission (p = 0.003), day 1 (p < 0.001), day 2 (p = 0.016), and last day (p = 0.007). No differences were observed based on sex. No difference in pain scores was observed. Nalbuphine resulted in less pain control in opioid-tolerant patients. Nalbuphine may represent an alternative first-line parenteral opioid in the acute care setting.

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