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Intravenous nalbuphine 50 µg·kg(-1) is ineffective for opioid-induced pruritus in pediatrics
Nao Nakatsuka1, Sean C Minogue1, Joanne Lim Masc1
1Department of Pediatric Anesthesia and Pain Management, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, V6H 3V4, Vancouver, British Columbia, Canada.
Insights
Nalbuphine did not effectively treat postoperative opioid-induced pruritus in pediatric patients. Further research is needed to evaluate the modified color analogue scale and pruritus intensity difference metrics.
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
- Pain Management
Background:
- Opioid analgesics are commonly used for postoperative pain management in children.
- Opioid-induced pruritus (Pr) is a frequent and bothersome side effect in pediatric patients.
- Effective management of pruritus is crucial for patient comfort and recovery.
Purpose of the Study:
- To evaluate the efficacy of nalbuphine in treating postoperative opioid-induced pruritus in pediatric patients.
- To assess the utility of a modified color analogue scale (CAS) for measuring pruritus intensity (PrI).
- To determine the effectiveness of a 50 µg·kg(-1) intravenous dose of nalbuphine compared to placebo.
Main Methods:
- A dual-site, tertiary care study enrolled 212 pediatric patients (age ≥ 7 years) receiving postoperative opioid analgesia.
- Patients with a PrI score ≥ 5/10 on a modified CAS were randomized to receive intravenous nalbuphine (50 µg·kg(-1)) or saline placebo.
- A positive outcome was defined as a pruritus intensity difference (PrID) of ≥ 50%.
Main Results:
- Of 212 subjects, 184 received opioids. Pruritus intensity ≥ 5/10 occurred in 20.1% of subjects.
- Intravenous morphine, particularly patient-controlled analgesia (PCA), was associated with pruritus in 68% of subjects.
- Nalbuphine achieved a PrID ≥ 50% in 55.6% of patients, while placebo achieved it in 57.9%, indicating no significant difference.
Conclusions:
- This preliminary study suggests that intravenous nalbuphine at 50 µg·kg(-1) is not effective in treating postoperative opioid-induced pruritus in pediatric patients.
- The modified CAS and PrID measures showed potential but require further investigation.
- Alternative or adjunct therapies may be necessary for managing pediatric opioid-induced pruritus.
Purpose:
This investigation evaluated the efficacy of nalbuphine in treating postoperative opioid-induced pruritus (Pr) in pediatric patients.
Methods:
After Ethics Board approval, the dual site, tertiary care teaching centre study recruited 212 subjects, age ≥ seven years, who received opioid analgesia postoperatively. A modified, self-report colour analogue scale (CAS) scored pruritus intensity (PrI). Subjects who reported PrI score ≥ 5/10 were randomized to treatment with nalbuphine 50 µg·kg(-1) iv (max 5 mg) or saline placebo. A pruritus intensity difference (PrID) ≥ 50% was considered a positive outcome.
Results:
Of 260 subjects approached, 212 consented and 184 received opioids. Median age was 13 yr (range 7-19) and median weight was 51 kg (range 19.6-134.8 kg). Pruritus intensity ≥ 5/10 occurred in 37 (20.1%) subjects. Intravenous morphine [patient-controlled analgesia (PCA)/continuous infusion] was associated with Pr in 68% of subjects over a wide dose range (9.4-63.2 µg·kg(-1)·hr(-1)). Pruritis occurred in 36% of patients in the PCA group compared to continuous opioid infusion (27%) and epidural administration (27%). Pruritus intensity difference ≥ 50% was achieved in 55.6% of nalbuphine and 57.9% of saline-treated subjects.
Conclusion:
This preliminary report suggests that nalbuphine 50 µg·kg(-1) iv is not effective in treating postoperative opioidinduced pruritus in pediatric patients. The modified CAS score and PrID warrant further investigation.
Objectif:
Évaluer l'efficacité de la nalbuphine contre le prurit (Pr) postopératoire induit par les opioïdes chez des patients pédiatriques. MéTHODE: Nous avons recruté 212 sujets de ≥ sept ans qui ont reçu une analgésie opioïde postopératoire. Une échelle analogique de couleur (EAC) modifiée pour l'auto-évaluation a mesuré les scores d'intensité du prurit (IPr). Répartis au hasard, les sujets dont les scores d'IPr étaient ≥ 5/10 ont reçu de la nalbuphine à 50 µg·kg(-1) iv (5 mg maximal) ou un placebo salin. Une différence d'intensité de prurit (DIPr) ≥50% était considérée positive. RéSULTATS: Des 260 sujets rencontrés, 212 ont participé à l'étude et 184 ont reçu des opioïdes. L'âge moyen a été de 13 ans (7-19) et le poids moyen de 51 kg (19,6-134,8 kg). Un prurit ≥ 5/10 a été noté chez 37 (20,1 %) des sujets. De la morphine intraveineuse [en analgésie auto-contrôlée (AAC) ou en perfusion continue] a été associée à du Pr chez 68 % des sujets pour un grand éventail de doses (9,4-63,2 µg·kg(-1)·h(-1)). Le prurit s'est manifesté chez 36 % des patients avec l'AAC comparée à la perfusion d'opioïde continue (27 %) et à l'administration péridurale (27 %). Une différence d'intensité du prurit ≥ 50 % a été atteinte chez 55,6 % des sujets qui recevaient la nalbuphine et 57,9 % de ceux qui avaient le placebo.
Conclusion:
La nalbuphine iv à 50 µg·kg(-1) n'est pas efficace pour traiter le prurit postopératoire induit par les opioïdes chez des patients pédiatriques. Le score modifié à l'EAC et la DIPr devront être étudiés plus à fond.
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