Comparison of postoperative analgesia and side effects in pediatric laparoscopic surgery with morphine and nalbuphine

Jia Chen; Cheng-Yu Wang; John Wei Zhong; Yu-Hang Cai; Jianmin Zhang; Fang Wang; Mazhong Zhang; Hongbin Gu; Hong-Yu Ma; Zhen Wang; Junzheng Wu; Hua-Cheng Liu

doi:10.1016/j.isci.2024.109287

Comparison of postoperative analgesia and side effects in pediatric laparoscopic surgery with morphine and nalbuphine

iScience. 2024 Feb 20;27(3):109287. doi: 10.1016/j.isci.2024.109287. eCollection 2024 Mar 15.

Authors

Jia Chen¹, Cheng-Yu Wang¹, John Wei Zhong², Yu-Hang Cai¹, Jianmin Zhang³, Fang Wang³, Mazhong Zhang⁴, Hongbin Gu⁴, Hong-Yu Ma¹, Zhen Wang⁵, Junzheng Wu⁶, Hua-Cheng Liu¹

Affiliations

¹ Department of Anaesthesiology and Perioperative Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University; Key Laboratory of Paediatric Anaesthesiology, Ministry of Education, Wenzhou Medical University; Key Laboratory of Anaesthesiology of Zhejiang Province, Wenzhou Medical University, Wenzhou, Zhejiang, China.
² Department of Anaesthesiology and Pain Management, University of Texas Southwestern Medical Centre, Dallas, TX, USA.
³ Department of Anesthesiology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
⁴ Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai 200127, China.
⁵ Laboratory Medicine Center, Allergy Center, Department of Transfusion Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China.
⁶ Department of Anesthesia and Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.

Abstract

There is currently no consensus on the optimal perioperative pain management strategy involving specific opioids. This study aims to compare the postoperative analgesia, the associated side effects between nalbuphine and morphine in children undergoing laparoscopic surgery. One hundred ninety children were randomly assigned to nalbuphine (0.2 mg/kg) or morphine (0.2 mg/kg). Nalbuphine's analgesic effect was non-inferior to morphine, with similar total rescue analgesic consumption during PACU stay (0.03 ± 0.05mg vs. 0.04 ± 0.06 mg, p > 0.05). Nalbuphine group had a lower incidence of respiratory depression (RR ≤ 10/min) (4.8% vs. 38.6%, p < 0.001), PONV (2.4% vs. 18.1%, p = 0.002), and pruritus (0% vs. 16.9%, p < 0.001) than morphine. Additionally, nalbuphine showed a shorter laryngeal mask airway removal time (13.9 [12.7, 15.1]) compared with morphine (17.0 [15.1, 18.9], p = 0.011). Nalbuphine provides equipotent analgesia with significantly lower incidences of respiratory depression, PONV, and pruritus compared with morphine in pediatric laparoscopic surgery.

Keywords: Biological sciences; Health sciences; Medical specialty; Medicine; Natural sciences; Neuroscience; Pharmacology; Sensory neuroscience; Surgery.