Nalbuphine may prevent postoperative delirium, agitation in kids undergoing ophthalmic procedures under GA

Perioperative pain management in children has long been a concern, and the occurrence of emergence delirium and agitation (EDA) after surgery is all too common. In a bid to address this issue, a recent study published in British Journal of Ophthalmology explored the use of nalbuphine as a potential solution for perioperative eye pain in children undergoing ophthalmic surgery under general anesthesia.

This retrospective cohort analysis involved 50 preschool-aged children who underwent ophthalmic surgery in a German university hospital between June 2020 and February 2021. These children were administered nalbuphine as a postoperative analgesic, and the impact on their pain management and incidence of EDA was closely monitored.

The group of children included 17 girls and 33 boys, with a median age of 20.5 months (ranging from 1 to 68 months) and a median body weight of 12.25 kilograms (ranging from 2.9 to 29 kilograms). As part of the standard procedure, all patients received ibuprofen at a dosage of 10 mg per kilogram during anesthesia induction. At the end of surgery, nalbuphine was administered at a dosage of 0.1 mg per kilogram.

All children in the study demonstrated low Pediatric-Anaesthesia-Emergence-Delirium-I-scores (PAED-ED-I Score) of less than 6 and had acceptable Face-Legs-Activity-Cry-Consolability-scores (FLACC scores of less than 3) upon awakening and when leaving the recovery room.

The results of this analysis are promising. Nalbuphine, administered as a postoperative analgesic in children undergoing ophthalmic surgery, has been found to offer sufficient pain relief. Furthermore, this study suggests that nalbuphine may contribute to a reduction in the incidence of EDA in these young patients.

While further research and larger studies will be needed to confirm these findings, this initial study offers hope for improving the comfort and well-being of children undergoing ophthalmic surgery. To make pediatric surgery less traumatic, the potential role of nalbuphine as a postoperative analgesic and its impact on EDA are subjects that warrant further exploration. 

Source:

Leister, N., Trieschmann, U., Yücetepe, S., Ulrichs, C., Muenke, N., Wendt, S., Menzel, C., & Heindl, L. M. (2022). Nalbuphine as analgesic in preschool children undergoing ophthalmic surgery and the occurrence of emergence delirium. In British Journal of Ophthalmology (Vol. 107, Issue 10, pp. 1522–1525). BMJ. https://doi.org/10.1136/bjo-2022-321575