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Intravenous nalbuphine 50 µg·kg^–1 is ineffective for opioid-induced pruritus in pediatrics

[La nalbuphine intraveineuse à 50 µg·kg^–1 est inefficace contre le prurit induit par les opioïdes chez des enfants]

Nao Nakatsuka, BSc^*, Sean C. Minogue, FFARCSI^*, Joanne Lim, MASc^*, Carolyne J. Montgomery, FRCPC^*, Colleen A. Court, BSN^*, Stephan Malherbe, FRCP, Yvonne Csanyi-Fritz, FRCPC^*, Ramona A. Kearney, FRCPC, Leeann Phillips, BSN, Kathy Reid, BNSc, Justin Kingsley, BSc and J. Mark Ansermino, FFA (SA)^*

^* From the Department of Anesthesia, Pharmacology and Therapeutics, BC Children’s Hospital, University of British Columbia; Vancouver, British Columbia; and the
Department of Anesthesiolgy and Pain Management, Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada.

Address correspondence to: Dr. C. Montgomery, Pediatric Anesthesia and Pain Management, British Columbia Children’s Hospital, University of British Columbia, 4480 Oak Street, Vancouver, British Columbia V6H 3V4, Canada. Phone: 604-875-2711; Fax: 604-875-3221; E-mail: cmontgomery{at}cw.bc.ca

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 opioid-induced pruritus in pediatric patients. The modified CAS score and PrID warrant further investigation.