Title	In IV Sedation Used for Dental Surgery, Neither Fentanyl or Nalbuphine More Effective As An Analgesic
Clinical Question	In a patient undergoing IV moderate conscious sedation associated with dental surgery, is fentanyl or nalbuphine more effective as a peri-operative analgesic?
Clinical Bottom Line	Neither fentanyl or nalbuphine is shown to have a clinical advantage as a peri-operative analgesic associated with IV moderate sedation in the dental office.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 3164051 Dolan/1998 50 patients, ASA 1 or 2 RCT Key results Dental surgery patients who required IV sedation, were given equipotent doses of either fentanyl or nalbuphine along with diazepam. There was no significant difference in pain relief, sedation, recall, and peri-operative vital signs. 8507018 Lefevre/1992 24 patients, ASA 3 or 4 RCT Key results ASA 3 and 4 patients who required IV sedation for dental surgery were given equipotent doses of either fentanyl or nalbuphine. There was no significant difference in pain relief, sedation, or post operative adverse effects. There was a difference in oxygen saturation during sedation as monitored by pulse oximetry. This effect should be considered when treating medically compromised patients, and may indicate the use of nalbuphine over fentanyl.
Evidence Search	nalbuphine fentanyl dental Filters: Randomized Controlled Trial 2nalbuphine fentanyl Filters: Randomized Controlled Trial34nalbuphine fentanyl160nalbuphine fentanyl Filters: Systematic Reviews3nalbuphine fentanyl Filters: Meta-Analysis2
Comments on The Evidence	Although there are higher levels of evidence published comparing these opioid analgesics in anesthesia, these two articles represent the best evidence using these medications associated with dental surgery and administered in a dental setting for IV moderate conscious sedation. All conclusions were statistically supported. Analgesic equivalence p>0.05. Decreased oxygen saturation p<0.05.
Applicability	Applicable to all dental providers utilizing IV moderate conscious sedation.
Specialty	(General Dentistry) (Oral Surgery) (Periodontics)
Keywords	Sedation, Fentanyl, Nalbuphine, Conscious Sedation, Opioid
ID#	2298
Date of submission	07/26/2012
E-mail	borgt@uthscsa.edu
Author	Tyler Borg
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Richard Finlayson, DDS
Faculty mentor e-mail	FINLAYSONR@UTHSCSA.EDU
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) by Tyler Borg (San Antonio, TX) on 09/12/2012 Fentanyl is a pure opioid agonist at the mu opioid receptor with high potency, and a short duration. Nalbuphine is a mixed agonist-antagonist with agonist action at the kappa opioid receptor, and antagonist action at the mu opioid receptor. Nalbuphine has a similar potency to the prototypical opioid, morphine, and has a long duration of action. Mixed agonist-antagonist opioid drugs are very similar to pure agonists, although the have less efficacy then the pure opioids. (Pharmacology and Therapeutics for Dentistry, 6th Edition, Yagiela et. al.) As a result, the anagelsic action for these drugs when used in conscious sedation is expected to be very similar.
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available