PT - JOURNAL ARTICLE AU - K P Houlihan AU - R G Mitchell AU - A D Flapan AU - D J Steedman TI - Excessive morphine requirements after pre-hospital nalbuphine analgesia. AID - 10.1136/emj.16.1.29 DP - 1999 Jan 01 TA - Journal of Accident & Emergency Medicine PG - 29--31 VI - 16 IP - 1 4099 - http://emj.bmj.com/content/16/1/29.short 4100 - http://emj.bmj.com/content/16/1/29.full SO - Arch Emerg Med1999 Jan 01; 16 AB - Nalbuphine hydrochloride is an opioid agonist-antagonist that has gained acceptance as a pre-hospital analgesic agent. Nalbuphine has equal analgesic properties to morphine, has a low addiction potential, and can be stored and administered without restrictions, unlike morphine. To date no clinical evidence has been published to support the theoretical difficulty that the action of opioids administered after nalbuphine could be altered or negated. The following case reports highlight 10 patients who received nalbuphine pre-hospital and subsequently required higher doses of opioid analgesia than expected. The discussion summarises the properties of nalbuphine and identifies potential reasons why excessive amounts of opioid analgesia were required.