Nalbuphine Dosing and Its Impact on Anxiety and Depression in Ectopic Pregnancy Surgery

Background:

Ectopic pregnancy occurs when a fertilized egg implants outside the uterine cavity, affecting approximately 2% of all pregnancies. Surgical intervention is the primary treatment, which can lead to significant psychological effects, including anxiety and depression. Studies indicate that patients may experience various emotional disturbances post-surgery, negatively impacting their social adaptability and interpersonal relationships. Effective postoperative pain management is crucial for recovery and may also help alleviate these emotional challenges. Nalbuphine, an opioid receptor agonist-antagonist that primarily acts on the kappa receptor, has been shown to provide pain relief with a lower incidence of respiratory depression and may have a positive impact on mental health compared to traditional opioids.

Objective:

The main objective is to investigate the effects of different concentrations of nalbuphine on anxiety and depression in patients with ectopic pregnancy post-surgery, focusing on changes in anxiety and depression scores on postoperative day three. The secondary objective is to compare the postoperative analgesic effects and the incidence of adverse reactions associated with different concentrations of nalbuphine.

Methods:

This study is designed as a single-center, prospective, randomized, controlled clinical trial conducted at Jinjiang District Maternal and Child Health Hospital. Ethical approval will be obtained, and all participants will provide informed consent.

Interventions:

165 eligible patients will be randomly assigned into three groups (N1, N2, N3), each receiving different doses of nalbuphine combined with metoclopramide for postoperative pain management, with a total volume of 150ml for each group. The groups are as follows:

• Group A: Nalbuphine 0.20 mg/ml (total 30 mg)
• Group B: Nalbuphine 0.27 mg/ml (total 40 mg)
• Group C: Nalbuphine 0.33 mg/ml (total 50 mg)

Patient-controlled analgesia (PCA) will be maintained for 48 hours.

Primary Outcome:

The primary outcome will be the assessment of anxiety and depression scores measured on postoperative day three.

Secondary Outcomes:

Secondary outcomes will include:

• Visual Analog Scale (VAS) resting and activity pain scores at multiple time points (T1: 6 hours, T2: 12 hours, T3: 24 hours, T4: 48 hours).
• Number of PCA button presses.
• Use and frequency of rescue analgesics.
• Incidence of adverse reactions such as drowsiness, dizziness, nausea, vomiting, and respiratory depression.
• Time to mobilization and time to first flatus.

Ethics Approval:

This study has received approval from the ethics committee of Chengdu Jinjiang District Maternal and Child Health Hospital (Approval Number: 202312). All participants must sign an informed consent form to ensure the respect of participant rights and data confidentiality. The study will strictly adhere to relevant ethical standards and legal regulations to protect participant safety and privacy.

Funding:

The study is funded by the Chengdu Medical Research Projects (No. 2023465, 2022548, and 2023304).

Inclusion criteria

• Confirmed diagnosis of ectopic pregnancy, aged ≥18 years, and with normal psychological status.
• Patients planned to undergo single-port laparoscopic surgery under general anesthesia, followed by postoperative patient-controlled intravenous analgesia (PCIA).
• Patients classified as ASA I or II.
• Able to understand the study process and methods, voluntarily participate, and sign the informed consent form.

Exclusion criteria

• Patients using other analgesic methods or multiple analgesic approaches.
• Patients with a history of allergies or allergies to anesthetic drugs.
• Patients with a history of depression or mental illness.
• Patients with other severe organ dysfunction.
• Patients unable to operate the intravenous analgesia pump independently.