JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (20) Citing Articles via Google Scholar Google Scholar Articles by Maxwell, L. G. Articles by Yaster, M. Search for Related Content PubMed PubMed Citation Articles by Maxwell, L. G. Articles by Yaster, M. Related Collections Pediatrics Pharmacology

---

PEDIATRIC ANESTHESIA

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

Lynne G. Maxwell, MD^*, Sandra C. Kaufmann, MD, Sally Bitzer, MD, Eric V. Jackson, Jr, MD, John McGready, MS, Sabine Kost-Byerly, MD, Lori Kozlowski, RN, Sharon K. Rothman, RN, and Myron Yaster, MD

*Department of Anesthesiology, The Children’s Hospital of Philadelphia, Pennsylvania; Department of Anesthesiology, The Joe DiMaggio Children’s Hospital, Hollywood, Florida; Departments of Anesthesiology, Critical Care Medicine, and Pediatrics, The Johns Hopkins Medical Institutions; and Department of Biostatistics, The Johns Hopkins University School of Public Health, Baltimore, Maryland

Address correspondence to Myron Yaster, MD, Richard J. Traystman Professor, Blalock 935, The Johns Hopkins Hospital, 600 North Wolfe St., Baltimore, MD 21287. Address e-mail to myaster{at}jhmi.edu.

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 µg · 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 consump-tion (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 µg · 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.

This article has been cited by other articles:

				M. K. Kim, S. B. Nam, M. J. Cho, and Y.-S. Shin Epidural naloxone reduces postoperative nausea and vomiting in patients receiving epidural sufentanil for postoperative analgesia Br. J. Anaesth., August 1, 2007; 99(2): 270 - 275. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999