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The effects of a small-dose naloxone infusion on opioid-induced side effects and analgesia in children and adolescents treated with intravenous patient-controlled analgesia: a double-blind, prospective, randomized, controlled study.
Anesth Analg. 2005 Apr; 100(4):953-8.A&A

Abstract

Opioids are frequently associated with side effects such as nausea, vomiting, and pruritus. We hypothesized that a prophylactic, continuous small-dose naloxone infusion would reduce the incidence of opioid-induced side effects without affecting analgesia or opioid consumption. In this prospective, double-blind, randomized, controlled clinical trial, we studied 46 postoperative patients (M:F, 21:25), averaging 14 +/- 2.5 yr and 53 +/- 17 kg, at the start of morphine IV patient-controlled analgesia. Patients were randomized to either saline (control, n = 26) or naloxone 0.25 microg . kg(-1) . h(-1) (n = 20). We found that the incidence and severity of pruritus (77% versus 20%; P < 0.05) and nausea (70% versus 35%; P < 0.05) was significantly more frequent in the placebo group compared with the naloxone group. Morphine consumption (1.02 +/- 0.41 mg . kg(-1) . d(-1) versus 1.28 +/- 0.61 mg . kg(-1) . d(-1)), pain scores at rest (4 +/- 2 versus 3 +/- 2), and pain scores with coughing (6 +/- 2 versus 6 +/- 2) were not different. We conclude that, in children and adolescents, a small-dose naloxone infusion (0.25 microg . kg(-1) . h(-1)) can significantly reduce the incidence and severity of opioid-induced side effects without affecting opioid-induced analgesia. When initiating morphine IV patient-controlled analgesia for the treatment of moderate to severe pain, clinicians should strongly consider starting a concomitant small-dose naloxone infusion.

Authors+Show Affiliations

Department of Anesthesiology, The Children's Hospital of Philadelphia, Pennsylvania, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15781505

Citation

Maxwell, Lynne G., et al. "The Effects of a Small-dose Naloxone Infusion On Opioid-induced Side Effects and Analgesia in Children and Adolescents Treated With Intravenous Patient-controlled Analgesia: a Double-blind, Prospective, Randomized, Controlled Study." Anesthesia and Analgesia, vol. 100, no. 4, 2005, pp. 953-8.
Maxwell LG, Kaufmann SC, Bitzer S, et al. The effects of a small-dose naloxone infusion on opioid-induced side effects and analgesia in children and adolescents treated with intravenous patient-controlled analgesia: a double-blind, prospective, randomized, controlled study. Anesth Analg. 2005;100(4):953-8.
Maxwell, L. G., Kaufmann, S. C., Bitzer, S., Jackson, E. V., McGready, J., Kost-Byerly, S., Kozlowski, L., Rothman, S. K., & Yaster, M. (2005). The effects of a small-dose naloxone infusion on opioid-induced side effects and analgesia in children and adolescents treated with intravenous patient-controlled analgesia: a double-blind, prospective, randomized, controlled study. Anesthesia and Analgesia, 100(4), 953-8.
Maxwell LG, et al. The Effects of a Small-dose Naloxone Infusion On Opioid-induced Side Effects and Analgesia in Children and Adolescents Treated With Intravenous Patient-controlled Analgesia: a Double-blind, Prospective, Randomized, Controlled Study. Anesth Analg. 2005;100(4):953-8. PubMed PMID: 15781505.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effects of a small-dose naloxone infusion on opioid-induced side effects and analgesia in children and adolescents treated with intravenous patient-controlled analgesia: a double-blind, prospective, randomized, controlled study. AU - Maxwell,Lynne G, AU - Kaufmann,Sandra C, AU - Bitzer,Sally, AU - Jackson,Eric V,Jr AU - McGready,John, AU - Kost-Byerly,Sabine, AU - Kozlowski,Lori, AU - Rothman,Sharon K, AU - Yaster,Myron, PY - 2005/3/23/pubmed PY - 2005/4/13/medline PY - 2005/3/23/entrez SP - 953 EP - 8 JF - Anesthesia and analgesia JO - Anesth. Analg. VL - 100 IS - 4 N2 - Opioids are frequently associated with side effects such as nausea, vomiting, and pruritus. We hypothesized that a prophylactic, continuous small-dose naloxone infusion would reduce the incidence of opioid-induced side effects without affecting analgesia or opioid consumption. In this prospective, double-blind, randomized, controlled clinical trial, we studied 46 postoperative patients (M:F, 21:25), averaging 14 +/- 2.5 yr and 53 +/- 17 kg, at the start of morphine IV patient-controlled analgesia. Patients were randomized to either saline (control, n = 26) or naloxone 0.25 microg . kg(-1) . h(-1) (n = 20). We found that the incidence and severity of pruritus (77% versus 20%; P < 0.05) and nausea (70% versus 35%; P < 0.05) was significantly more frequent in the placebo group compared with the naloxone group. Morphine consumption (1.02 +/- 0.41 mg . kg(-1) . d(-1) versus 1.28 +/- 0.61 mg . kg(-1) . d(-1)), pain scores at rest (4 +/- 2 versus 3 +/- 2), and pain scores with coughing (6 +/- 2 versus 6 +/- 2) were not different. We conclude that, in children and adolescents, a small-dose naloxone infusion (0.25 microg . kg(-1) . h(-1)) can significantly reduce the incidence and severity of opioid-induced side effects without affecting opioid-induced analgesia. When initiating morphine IV patient-controlled analgesia for the treatment of moderate to severe pain, clinicians should strongly consider starting a concomitant small-dose naloxone infusion. SN - 0003-2999 UR - https://www.unboundmedicine.com/medline/citation/15781505/The_effects_of_a_small_dose_naloxone_infusion_on_opioid_induced_side_effects_and_analgesia_in_children_and_adolescents_treated_with_intravenous_patient_controlled_analgesia:_a_double_blind_prospective_randomized_controlled_study_ L2 - http://dx.doi.org/10.1213/01.ANE.0000148618.17736.3C DB - PRIME DP - Unbound Medicine ER -