Dinalbuphine Sebacate Boosts Pain Management After Thoracoscopic Surgery, finds study

Tackling Pain After Lung Surgery

Video-assisted thoracoscopic surgery (VATS) is favored for lung procedures due to smaller incisions and faster recovery, but patients still often face moderate to severe postoperative pain. Traditionally, pain control relies on a combination of non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and opioids—each with their own drawbacks. The search for effective, opioid-sparing strategies has led researchers to explore innovative multimodal analgesia (MMA) approaches.

Dinalbuphine Sebacate: A Promising Addition

Dinalbuphine sebacate (DS) is a long-acting form of nalbuphine that acts on both µ- and κ-opioid receptors. Approved in Taiwan, DS provides extended pain relief without the high risk of respiratory depression or euphoria associated with traditional opioids. This study, published in BMC Anesthesiology, set out to evaluate the effectiveness of DS as part of an MMA regimen for patients undergoing VATS.

Methodology: Rigorous, Double-Blind Testing

Sixty patients scheduled for VATS were randomly assigned to receive either DS or a placebo (sesame oil) intramuscular injection after anesthesia induction. All participants also received a thoracic paravertebral block (TPVB) and standard perioperative pain medications. Patient-controlled fentanyl was available postoperatively for breakthrough pain. The main outcome measured was the total amount of fentanyl used in the first three days after surgery.

Results: Less Opioid Use, Better Recovery

The findings were striking. The DS group used far less fentanyl—an average of 283 µg versus 708 µg in the placebo group—over three days post-surgery. Notably, patients in the DS group reported less pain interference with daily activities at both one week (29% vs. 86%) and one month after surgery (11% vs. 48%). Movement-related pain scores were also significantly lower in the DS group at both follow-up points.

Side Effects and Safety

DS did cause a higher rate of mild dizziness compared to placebo, mainly during the peak absorption period, but no serious adverse events or significant differences in nausea, vomiting, or local injection reactions were observed. Both groups had similar satisfaction levels with their pain management.

Implications: Toward Better Multimodal Analgesia

This study demonstrates that adding DS to MMA protocols can substantially reduce the need for opioids after VATS, improve functional recovery, and provide long-lasting pain relief even after hospital discharge. The results support considering DS as a valuable component in surgical pain management strategies, though its mild side effect of dizziness calls for attentive patient monitoring.

Key Takeaways

• DS as part of MMA significantly reduced fentanyl consumption after VATS.

• Patients receiving DS experienced less pain and interference with daily life post-surgery.

• DS provided prolonged pain relief up to one month after discharge.

• Mild, transient dizziness was more common with DS but quickly resolved.

• No increase in serious adverse events or other complications was seen.

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. Effect of Dinalbuphine sebacate on postoperative multimodal analgesic strategy in video-assisted thoracoscopic surgery: a double-blind randomized controlled trial. BMC Anesthesiology. 2025;25:252. https://doi.org/10.1186/s12871-025-03118-7