Dinalbuphine Ester (Naldebain) for Pain Management After Cesarean Section

Recruiting now · Phase 2/Phase 3

Conditions studied: Postsurgical Pain, Cesarean Section, Chronic Post-surgical Pain

In brief

Inadequate postoperative pain management can lead to physical and psychological distress in patients as well as impact surgical wound healing and increase the risk of developing postoperative delirium and cardiopulmonary and thromboembolic events. Severe postoperative pain may also result in the development of chronic post-surgical pain (CPSP), which in turn can lead to prolonged use of opioids and increased health-care costs. A descriptive survey study in 60 postpartum women who received cesarean section suggested that the presence of postoperative pain significantly reduced the willingness of breastfeeding and infant care. The incidence of CPSP after cesarean delivery has been reported to vary from 1% to 18% up to 1 year after operation. Intrathecal morphine (ITM) injection is considered as the standard pain management strategy for post-cesarean pain. However, the overall analgesic effect of ITM is about 8-12h and it is associated with pruritus, nausea/vomiting, urinary retention, constipation, mental status change, and respiratory depression. Therefore, the development of a safe, conveniently operated, and long-lasting analgesic strategy, which serves as background pain control modality up to several days after cesarean section should provide clinically beneficial advantages in the management of acute postoperative pain and prevention of CPSP in postpartum women. Naldebain® is prodrug of nalbuphine, which was approved by the Taiwan FDA in 2017. Naldebain® is rapidly hydrolyzed by tissue of plasma esterase to release nalbuphine. The bioavailability of nalbuphine following intramuscular injection Naldebain® was 85.4%, and it took approximately 6 days for the complete release of Naldebain® into the blood circulation. Therefore, a single parenteral injection of Naldebain® could provide long lasting analgesic effect in several phase II trials. However, Naldebain® has not been tested in the pain control after cesarean section. Therefore, this PI-initiated prospective, randomized, open-label, non-inferiority trial aims to investigate the clinical efficacy of Naldebain® in management of acute postoperative pain in term parturient who receive elective cesarean section to provide analgesic effect that is not inferior to the standard ITM and prevent the development of CPSP.

Key facts

Study ID

NCT06344169

Run by

Dalin Tzu Chi General Hospital

People needed

120

Starts

2024-05-06

Expected to finish

2026-06-14

Last updated by the study team

2025-05-09

Who can join

Age: 20 and older. Sex: female. Healthy volunteers: not accepted.

You may qualify if…

• term primipara or multipara who are scheduled for elective cesarean section

You may not qualify if…

• Severe pregnancy-induced complication (such as preeclampsia, eclampsia, poorly control pregnancy-induced hypertension and/or diabetes)
• High risk for postpartum hemorrhage
• Contraindicated for neuraxial block
• Preterm (gestational age< 36 week) delivery
• Emergency cesarean section
• After-office hour schedule
• History of substance abuse
• Known allergy to nalbuphine, benzyl benzoate or sesame oil
• Eligible parturient who are not willing to follow the assignment of treatment after randomization

Where it is running

• Dalin Tzu Chi Hospital — Dalin, Chai-Yi, Taiwan (enrolling)

Full record on ClinicalTrials.gov

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