ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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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 (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 3164051Dolan/199850 patients, ASA 1 or 2RCT
Key resultsDental 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.
#2) 8507018Lefevre/199224 patients, ASA 3 or 4RCT
Key resultsASA 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 Trial 34nalbuphine fentanyl 160nalbuphine fentanyl Filters: Systematic Reviews 3nalbuphine fentanyl Filters: Meta-Analysis 2
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/Discipline (General Dentistry) (Oral Surgery) (Periodontics)
Keywords Sedation, Fentanyl, Nalbuphine, Conscious Sedation, Opioid
ID# 2298
Date of submission: 07/26/2012spacer
E-mail borgt@uthscsa.edu
Author Tyler Borg
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Richard Finlayson, DDS
Faculty mentor/Co-author 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?)
post a rationale
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.
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