title: Intravenous nalbuphine 50 µg·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 ≥ 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.
  
  
  CONCLUSIONS
  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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Pediatric Anesthesia and Pain Management, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, V6H 3V4, Vancouver, British Columbia, Canada.
authors: Nao
authors: N
authors: Nakatsuka
authors: Department of Pediatric Anesthesia and Pain Management, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, V6H 3V4, Vancouver, British Columbia, Canada.
authors: Sean C
authors: SC
authors: Minogue
authors: Department of Pediatric Anesthesia and Pain Management, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, V6H 3V4, Vancouver, British Columbia, Canada.
authors: Joanne
authors: J
authors: Lim Masc
authors: Department of Pediatric Anesthesia and Pain Management, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, V6H 3V4, Vancouver, British Columbia, Canada. cmontgomery@cw.bc.ca.
authors: Carolyne J
authors: CJ
authors: Montgomery
authors: Department of Pediatric Anesthesia and Pain Management, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, V6H 3V4, Vancouver, British Columbia, Canada.
authors: Colleen A
authors: CA
authors: Court
authors: Department of Pediatric Anesthesia and Pain Management, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, V6H 3V4, Vancouver, British Columbia, Canada.
authors: Yvonne
authors: Y
authors: Csanyi-Fritz
authors: Department of Pediatric Anesthesia and Pain Management, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, V6H 3V4, Vancouver, British Columbia, Canada.
authors: J Mark
authors: JM
authors: Ansermino
authors: Department of Anesthesiolgy and Pain Management, University of British Columbia, Vancouver, British Columbia.|Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
authors: Stephan
authors: S
authors: Malherbe
authors: Department of Anesthesiolgy and Pain Management, University of British Columbia, Vancouver, British Columbia.|Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
authors: Ramona A
authors: RA
authors: Kearney
authors: Department of Anesthesiolgy and Pain Management, University of British Columbia, Vancouver, British Columbia.|Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
authors: Leeann
authors: L
authors: Phillips
authors: Department of Anesthesiolgy and Pain Management, University of British Columbia, Vancouver, British Columbia.|Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
authors: Kathy
authors: K
authors: Reid
authors: Department of Anesthesiolgy and Pain Management, University of British Columbia, Vancouver, British Columbia.|Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
authors: Justin
authors: J
authors: Kingsley