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Intravenous nalbuphine 50 microg x kg(-1) is ineffective for opioid-induced pruritus in pediatrics

Nao Nakatsuka1, Sean C Minogue, Joanne Lim

  • 1Department of Anesthesia, Pharmacology and Therapeutics, BC Children's Hospital, University of British Columbia; Vancouver, British Columbia, Canada.

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|November 3, 2006
PubMed

Insights

Nalbuphine did not effectively treat itching in pediatric patients after surgery. Further research is needed on the modified color analogue scale and pruritus intensity difference measures.

Area of Science:

  • Anesthesiology
  • Pharmacology
  • Pediatric Medicine

Background:

  • Postoperative pruritus (Pr) is a common side effect of opioid analgesia in pediatric patients.
  • Effective management of opioid-induced pruritus is crucial for patient comfort and recovery.
  • Nalbuphine is an opioid agonist-antagonist with potential anti-pruritic properties.

Purpose of the Study:

  • To evaluate the efficacy of nalbuphine in treating postoperative opioid-induced pruritus in pediatric patients.
  • To assess the effectiveness of a 50 microg x kg(-1) intravenous dose of nalbuphine compared to placebo.

Main Methods:

  • A dual-site, tertiary care teaching center study enrolled 212 pediatric patients (age >= 7 years) receiving postoperative opioid analgesia.
  • Pruritus intensity (PrI) was measured using a modified self-report color analogue scale (CAS).
  • Patients with PrI score >= 5/10 were randomized to receive intravenous nalbuphine (50 microg x kg(-1)) or saline placebo.

Main Results:

  • Of 212 subjects, 37 (20.1%) experienced pruritus intensity >= 5/10.
  • Intravenous morphine, particularly patient-controlled analgesia (PCA), was associated with a high incidence of pruritus (68%).
  • Nalbuphine (55.6%) and saline placebo (57.9%) showed similar efficacy in achieving a >= 50% pruritus intensity difference.

Conclusions:

  • Nalbuphine 50 microg x kg(-1) intravenous administration is not effective in treating postoperative opioid-induced pruritus in pediatric patients.
  • The modified CAS and pruritus intensity difference (PrID) metrics require further investigation for their utility.
  • This preliminary report highlights the need for alternative strategies to manage pruritus in pediatric surgical patients.
Abstract

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