title: Intravenous nalbuphine 50 microg x kg(-1) is ineffective for opioid-induced pruritus in pediatrics.
abstract: 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.
authors.affiliation: Department of Anesthesia, Pharmacology and Therapeutics, BC Children's Hospital, University of British Columbia; Vancouver, British Columbia, Canada.
authors.forename: Nao
authors.initials: N
authors.lastname: Nakatsuka
authors.forename: Sean C
authors.initials: SC
authors.lastname: Minogue
authors.forename: Joanne
authors.initials: J
authors.lastname: Lim
authors.forename: Carolyne J
authors.initials: CJ
authors.lastname: Montgomery
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Court
authors.forename: Stephan
authors.initials: S
authors.lastname: Malherbe
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Csanyi-Fritz
authors.forename: Ramona A
authors.initials: RA
authors.lastname: Kearney
authors.forename: Leeann
authors.initials: L
authors.lastname: Phillips
authors.forename: Kathy
authors.initials: K
authors.lastname: Reid
authors.forename: Justin
authors.initials: J
authors.lastname: Kingsley
authors.forename: J Mark
authors.initials: JM
authors.lastname: Ansermino
mesh_terms: 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*
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009266:Nalbuphine