Intravenous nalbuphine 50 µg·kg(-1) is ineffective for opioid-induced pruritus in pediatrics.

Autor: Nakatsuka N; 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., Minogue SC; 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., Lim Masc J; 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., Montgomery CJ; 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., Court CA; 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., Csanyi-Fritz Y; 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., Ansermino JM; 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., Malherbe S; Department of Anesthesiolgy and Pain Management, University of British Columbia, Vancouver, British Columbia.; Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada., Kearney RA; Department of Anesthesiolgy and Pain Management, University of British Columbia, Vancouver, British Columbia.; Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada., Phillips L; Department of Anesthesiolgy and Pain Management, University of British Columbia, Vancouver, British Columbia.; Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada., Reid K; Department of Anesthesiolgy and Pain Management, University of British Columbia, Vancouver, British Columbia.; Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada., Kingsley J; Department of Anesthesiolgy and Pain Management, University of British Columbia, Vancouver, British Columbia.; Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
Jazyk: angličtina
Zdroj: Canadian journal of anaesthesia = Journal canadien d'anesthesie [Can J Anaesth] 2006 Nov; Vol. 53 (11), pp. 1103-10.
DOI: 10.1007/BF03022878
Abstrakt: 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.
Databáze: MEDLINE
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