Intravenous nalbuphine 50 microg x kg(-1) is ineffective for opioid-induced pruritus in pediatrics.
OBJECTIVE
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 > or = seven years, who received opioid analgesia postoperatively. A modified, self-report colour analogue scale (CAS) scored pruritus intensity (PrI). Subjects who reported PrI score > or = 5/10 were randomized to treatment with nalbuphine 50 microg x kg(-1) iv (max 5 mg) or saline placebo. A pruritus intensity difference (PrID) > or = 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 > or = 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 mug.kg(-1).hr(-1)). Pruritus occurred in 36% of patients in the PCA group compared to continuous opioid infusion (27%) and epidural administration (27%). Pruritus intensity difference > or = 50% was achieved in 55.6% of nalbuphine and 57.9% of saline-treated subjects.


CONCLUSIONS
This preliminary report suggests that nalbuphine 50 microg x kg(-1) iv is not effective in treating postoperative opioid-induced pruritus in pediatric patients. The modified CAS score and PrID warrant further investigation.
Nakatsuka
Nao
N
Department of Anesthesia, Pharmacology and Therapeutics, BC Children's Hospital, University of British Columbia; Vancouver, British Columbia, Canada.
Minogue
Sean C
SC
Lim
Joanne
J
Montgomery
Carolyne J
CJ
Court
Colleen A
CA
Malherbe
Stephan
S
Csanyi-Fritz
Yvonne
Y
Kearney
Ramona A
RA
Phillips
Leeann
L
Reid
Kathy
K
Kingsley
Justin
J
Ansermino
J Mark
JM
D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D002648:Child; D003625:Data Collection; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D009266:Nalbuphine / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced* / Q000188:drug therapy*
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009266:Nalbuphine