Dinalbuphine Sebacate Reduces Opioid Use and Pain After Thoracoscopic Surgery, study finds

Postoperative pain management is a significant concern for patients undergoing video-assisted thoracoscopic surgery (VATS). Traditionally, multimodal analgesia (MMA)—combining regional anesthesia, NSAIDs, acetaminophen, and opioids—aims to optimize pain relief while minimizing opioid use. However, the search continues for strategies that further enhance pain control and recovery. One promising option is dinalbuphine sebacate (DS), a long-acting prodrug of nalbuphine, known for its ability to provide prolonged pain relief.

A recent double-blind, randomized controlled trial published in BMC Anesthesiology investigated the effectiveness of adding DS to an MMA protocol for patients undergoing VATS. Sixty participants were randomly assigned to receive either DS or a placebo injection, both in addition to a standard regimen that included a thoracic paravertebral block (TPVB) and patient-controlled analgesia (PCA) with fentanyl for breakthrough pain.

The results were compelling: patients who received DS required significantly less fentanyl in the first three postoperative days (283 µg vs. 708 µg). Not only did DS reduce opioid consumption, but it also led to lower pain scores during movement and at rest, both in the hospital and up to a month after surgery. Furthermore, fewer patients in the DS group reported that pain interfered with their daily activities at one week and one month post-surgery, highlighting improved functional recovery.

Safety was also assessed. While mild dizziness was reported more frequently with DS, there were no significant differences in rates of nausea, vomiting, or injection-site discomfort compared to placebo. Patient satisfaction with pain management was high in both groups.

The study demonstrates that integrating DS into MMA protocols for VATS can enhance analgesia, reduce opioid requirements, and improve recovery without compromising safety. The authors note that further, longer-term studies are needed, but these findings mark an important step in multimodal perioperative pain care.

Key Takeaways:

• Adding dinalbuphine sebacate (DS) to multimodal analgesia for VATS significantly reduces opioid (fentanyl) consumption postoperatively.

• DS decreases both acute and longer-term pain, with fewer patients experiencing pain that limits daily activities after surgery.

• Side effects, including dizziness and nausea, were mild and comparable to placebo, with high overall patient satisfaction.

• DS represents a promising advance in perioperative pain management, supporting functional recovery and reducing opioid reliance after thoracic surgery.

Citation:

Hsu, H-T., Ma, C-W., Chang, P-C., Kuo, Y-W., Gau, T-P., Liu, Y-W., Liu, Y-C., Chou, S-H., & Cheng, K-I. (2025). Effect of Dinalbuphine sebacate on postoperative multimodal analgesic strategy in video-assisted thoracoscopic surgery: a double-blind randomized controlled trial. BMC Anesthesiology, 25, 252. https://doi.org/10.1186/s12871-025-03118-7