Nalbuphine May Be Superior to Sufentanil in Relieving Postcesarean Uterine Contraction Pain in Multiparas: A Retrospective Cohort Study

Figures & data

Figure 1 Flowchart schematic for participant inclusion in the trial. 674 patients were included in our trial. In the unmatched cohort, 306 cases in the Nalbuphine group and 368 cases in the Sufentanil group. In the matched cohort, there are 306 cases in both the Nalbuphine and Sufentanil groups.

Table 1 Demographics and Characteristics of Participants

Characteristic	Unmatched Cohort				Matched Cohort
	Total (n = 674)	Sufentanil (n = 306)	Nalbuphine (n = 368)	p-value	Total (n = 612)	Sufentanil (n = 306)	Nalbuphine (n = 306)	p-value
Age, median (IQR), years	30 (28–34)	30 (28–33)	30 (28–35)	0.396	30 (28–34)	30 (28–33)	30 (27–35)	0.545
Height, median (IQR), cm	164 (159–168)	164 (159–168)	163 (158–167)	0.013	164 (159–167)	164 (159–169)	163 (159–167)	0.119
BW, median (IQR), kg	72 (66–79)	72 (66–80)	71.8 (65–78)	0.325	72 (66–78.5)	72 (66–80)	71 (65–78)	0.232
BMI, median (IQR), kg/m^2	27 (24–30)	26 (24–30)	27 (24–30)	0.950	27 (24–30)	26 (24–30)	27 (24–29)	0.626
Primiparous, n (%)				0.801				0.870
Yes	389/674 (58%)	175/306 (57%)	214/368 (58%)		352/612 (58%)	175/306 (57%)	177/306 (58%)
No	285/674 (42%)	131/306 (43%)	154/368 (425)		260/612 (42%)	131/306 (43%)	129/306 (42%)
Gestational hypertension, n (%)	266/674 (40%)	121/306 (40%)	145/368 (39%)	0.970	250/612 (41%)	121/306 (40%)	131/306 (42%)	0.460
Gestational diabetes mellitus, n (%)	171/674 (26%)	79/306 (26%)	92/368 (25%)	0.808	163/612 (27%)	79/306 (26%)	84/306 (28%)	0.715
Placenta previa, n (%)	132/674 (20%)	57/306 (19%)	75/368 (20%)	0.568	119/612 (19%)	57/306 (19%)	62/306 (20%)	0.683
Gestational age, median (IQR), weeks	38 (37–39)	38 (37–40)	38 (37–39)	0.519	38 (37–39)	38 (37–40)	38 (37–39)	0.093
BW of newborn, median (IQR), kg	3.4 (2.9–4.0)	3.5 (2.9–4.1)	3.3 (2.9–3.9)	0.430	3.5 (2.9–4.0)	3.5 (2.9–4.1)	3.4 (2.9–3.8)	0.516
ASA grade, n (%)				0.477				0.681
I	272/674 (40%)	128/306 (42%)	144/368 (39%)		251/612 (41%)	128/306 (42%)	123/306 (40%)
II	402/674 (60%)	178/306 (58%)	224/368 (61%)		361/612 (59%)	178/306 (58%)	183/306 (60%)
Operation duration, median (IQR), min	63 (54–72)	64 (55–72)	62 (54–71)	0.341	63 (55–72)	64 (55–72)	63 (55–69)	0.604
Blood loss in surgery, median (IQR), mL	320 (275–355)	320 (275–360)	310 (270–340)	0.038	315 (275–355)	320 (275–360)	310 (270–345)	0.361
Volume of lochia 12 h after CS, median (IQR), mL	100 (70–140)	95 (70–135)	100 (75–145)	0.022	100 (75–140)	95 (70–135)	100 (75–145)	0.147
Anesthesiology, n (%)				0.285				0.291
General anesthesia	70/674 (10%)	36/306 (12%)	34/368 (9%)		64/612 (11%)	36/306 (12%)	28/306 (9%)
Spinal anesthesia	604/674 (90%)	270/306 (88%)	334/368 (91%)		548/612 (89%)	270/306 (88%)	278/306 (91%)
Hospital stays, median (IQR), days	3 (3–3)	3 (3–3)	3 (3–3)	0.945	3 (3–3)	3 (3–3)	3 (3–3)	0.849
Hospitalization satisfaction, median (IQR)	4 (4–5)	4 (4–5)	4 (4–5)	0.249	4 (4–5)	4 (4–5)	4 (4–5)	0.153

Note: Bold values denote statistical significance at the p<0.05 level.

Abbreviations: ASA, American Society of Anesthesiologists; BMI, body mass index; BW, body weight; IQR, interquartile range.

Table 2 Primary, Secondary, and Side Effects Outcomes

Items	Unmatched Cohort			Matched Cohort
	Sufentanil (n = 306)	Nalbuphine (n = 368)	p-value	Sufentanil (n = 306)	Nalbuphine (n = 306)	p-value
Primary outcome, mean (SD)
POD1 VAS-contraction,	3.6 (1.3)	3.3 (1.2)	<0.001	3.6 (1.3)	3.32 (1.2)	<0.001
POD2 VAS-contraction	3.4 (1.4)	3.18 (1.0)	0.019	3.4 (1.4)	3.18 (1.0)	0.026
Secondary outcome
POD1, mean (SD)
VAS-rest	1.5 (1.2)	1.4 (1.0)	0.221	1.5 (1.2)	1.5 (1.1)	0.417
VAS-movement	2.8 (1.1)	2.5 (0.7)	<0.001	2.8 (1.1)	2.5 (0.7)	<0.001
Sedation^a	2.0 (0.2)	2.0 (0.1)	0.065	2.0 (0.2)	2.0 (0.1)	0.058
Activity^b	3.1 (0.6)	3.1 (0.4)	0.980	3.1 (0.6)	3.1 (0.5)	0.924
Sleep^c	35 (6)	34 (7)	0.430	35 (6)	34 (7)	0.597
POD2, mean (SD)
VAS-rest	1.3 (1.1)	1.3 (1.9)	0.868	1.3 (1.1)	1.3 (1.0)	0.968
VAS-movement	2.5 (1.4)	2.6 (0.7)	0.881	2.5 (1.4)	2.6 (0.7)	0.854
Sedation	2.0 (0.2)	2.0 (0.0)	0.121	2.0 (0.2)	2.0 (0.0)	0.157
Activity	2.5 (0.7)	3.1 (0.4)	0.973	2.5 (0.7)	2.6 (0.6)	0.596
Sleep	35 (6)	35 (6)	0.332	35 (6	35 (6)	0.501
POD1 & POD2, mean (SD)
PCIA attempts	14 (7)	12 (5)	0.028	14 (7)	12 (5)	0.058
PCIA injections	13 (7)	9 (5)	<0.001	13 (7)	9 (5)	<0.001
Rescue analgesia, n (%)	6/306 (2.0%)	14/368 (3.8%)	0.160	6/306 (0%)	11/368 (0%)	0.219
Analgesia consumption, (morphine equivalents) mg	113 (15)	113 (23)	0.868	113 (15)	113/368 (23)	0.974
Flatus, n (%)	108/306 (35%)	112/368 (30%)	0.206	108/306 (35%)	94/368 (31%)	0.250
Side effects outcome
POD1, n (%)
Pruritus	7/306 (2.3%)	0/368 (0%)	0.004	7/306 (2.3%)	0/368 (0%)	0.008
PONV	26/306 (9%)	10/368 (2.7%)	0.001	26/306 (9%)	8/368 (2.6%)	0.003
Uroschesis	20/306 (7%)	0/368 (0%)	<0.001	20/306 (7%)	0/368 (0%)	<0.001
POD2, n (%)
Pruritus	2/306 (0.7%)	3/368 (0.8%)	0.808	2/306 (0.7%)	2/368 (0.7%)	1.000
PONV	2/306 (0.7%)	2/368 (0.5%)	0.427	2/306 (0.7%)	2/368 (0.7%)	0.606
Uroschesis	14/306 (4.6%)	2/368 (0.5%)	0.001	14/306 (4.6%)	2/368 (0.7%)	0.002

Notes: ^aSedation was assessed with the Modified Ramsay Sedation Score; ^bActivity was assessed with UCLA Activity Scale; ^cSleep was assessed with Self-Rating Scale of Sleep Scale. Bold values denote statistical significance at the p<0.05 level.

Abbreviations: ASA, American Society of Anesthesiologists; BMI, body mass index; BW, body weight; PCIA, patient-controlled intravenous analgesia; POD1, postoperative day one; POD2, postoperative day two; PONV, postoperative nausea and vomiting; SD, standard deviation; VAS, Visual Analog Scale.

Figure 2 Multiple logistic regression model for predictors may affecting visceral pain. The results showed that multiparous and increased total analgesic consumption were associated with increased odds of suffering from severe uterine contraction pain. Bold values denote statistical significance at the p<0.05 level.

Abbreviations: aOR, adjusted odds ratio; ASA, American Society of Anesthesiologists; CI, confidence interval; GA, general anesthesia; SA, spinal anesthesia.

Table 3 Subgroup Analyses of Clinical Characteristics Associated with Pain Management

Items	Primiparous Patients			Multiparous Patients
	Sufentanil (n = 175)	Nalbuphine (n = 214)	p-value	Sufentanil (n = 131)	Nalbuphine (n = 154)	p-value
POD1, mean (SD)
VAS-rest	1.3 (1.0)	1.4 (1.0)	0.204	1.8 (1.4)	1.4 (1.0)	0.004
VAS-movement	2.6 (0.9)	2.5 (0.7)	0.229	3.1 (1.3)	2.5 (0.7)	<0.001
VAS-contraction	3.3 (1.1)	3.3 (1.2)	0.614	3.9 (1.3)	3.2 (1.2)	<0.001
Sedation^a	2.0 (0.2)	2.0 (0.1)	0.066	2.0 (0.0)	2.0 (0.0)	1
Activity^b	3.1 (0.7)	3.1 (0.5)	0.339	3.2 (0.4)	2.5 (0.6)	0.127
Sleep^c	34 (7)	34 (7)	0.989	35 (6)	34 (7)	0.213
POD2, mean (SD)
VAS-rest	1.1 (0.8)	1.3 (1.0)	0.014	1.6 (1.3)	1.4 (0.8)	0.038
VAS-movement	2.4 (1.3)	2.5 (0.7)	0.365	2.8 (1.5)	2.7 (0.7)	0.490
VAS-contraction	3.3 (1.4)	3.2 (1.0)	0.309	3.6 (1.4)	3.2 (0.8)	0.019
Sedation	2.0 (0.2)	2.0 (0.0)	0.158	2.0 (0.0)	2.0 (0.0)	1
Activity	2.5 (0.7)	2.5 (0.6)	0.470	2.6 (0.6)	2.5 (0.6)	0.384
Sleep	36 (6)	35 (6)	0.269	35 (6)	35 (6)	0.823
POD1 & POD2
PCIA attempts, mean (SD)	14 (8)	11 (5)	0.520	15 (8)	13 (6)	0.252
PCIA injections, mean (SD)	12 (5)	9 (4)	0.001	13 (5)	9 (5)	0.008
Rescue analgesia, n (%)	4/175 (2.3%)	9/214 (4.2%)	0.399	2/131 (1.5%)	5/154 (3.2%)	0.458
Analgesia consumption, (morphine equivalents), mean (SD), mg	112 (16)	111 (20)	0.568	114 (22)	113 (20)	0.901

Notes: ^aSedation was assessed with the Modified Ramsay Sedation Score; ^bActivity was assessed with UCLA Activity Scale; ^cSleep was assessed with Self-Rating Scale of Sleep Scale. Bold values denote statistical significance at the p<0.05 level.

Abbreviations: PCIA, patient-controlled intravenous analgesia; POD1, postoperative day one; POD2, postoperative day two; SD, standard deviation; VAS, Visual Analog Scale.