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Effects of low-dose naloxone on opioid therapy in pediatric patients: a retrospective case-control study

  • Pediatric Brief Report
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Abstract

Objective

To develop novel therapies that prevent opioid tolerance in critically ill children we examined the effects of low-dose naloxone infusions on patients' needs for analgesia or sedation.

Design and setting

Matched case-control study in a pediatric intensive care unit at a university children's hospital.

Patients

We compared 14 pediatric ICU patients receiving low-dose naloxone and opioid infusions with 12 matched controls receiving opioid infusions.

Measurements and main results

Opioid analgesia and sedative requirements were assessed as morphine- and midazolam-equivalent doses, respectively. No differences were observed between groups in opioid doses at baseline or during naloxone, but in the postnaloxone period opioid doses tended to be lower in the naloxone group. Compared to baseline the naloxone group required more opioids during naloxone but fewer opioids after naloxone. Total sedative doses were comparable at baseline in both groups, with no differences in the postnaloxone period. The naloxone group required less sedation after naloxone but sedation doses were unchanged in controls. The two groups did not differ in pain scores, sedation scores, or opioid side effects.

Conclusions

Naloxone did not reduce the need for opioid during the infusion period but tended to reduce opioid requirements in the postnaloxone period without additional need for sedation. Randomized clinical trials may examine the effects of low-dose naloxone on opioid tolerance and side effects in pediatric ICU patients requiring prolonged opioid analgesia.

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Acknowledgements

The authors thank J.M. Tilford, Ph.D. for help with PRISM analyses. The work was performed at Arkansas Children's Hospital Research Institute.

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Authors and Affiliations

  1. Department of Pediatric Surgery, University Medical Center and Erasmus MC, Sophia Children’s Hospital, Rotterdam, The Netherlands

    C. L. S. Cheung, M. van Dijk & D. Tibboel

  2. Department of Pediatrics, College of Medicine, University of Arkansas and Arkansas Children’s Hospital, 800 Marshall Street, 72202, Little Rock, AR, USA

    J. W. Green & K. J. S. Anand

  3. Departments of Anesthesiology, Neurobiology and Pharmacology, College of Medicine, Medical School, University of Arkansas and Arkansas Children’s Hospital, 800 Marshall Street, 72202, Little Rock, AR, USA

    K. J. S. Anand

Authors
  1. C. L. S. Cheung
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  2. M. van Dijk
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  3. J. W. Green
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  4. D. Tibboel
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  5. K. J. S. Anand
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Corresponding author

Correspondence to K. J. S. Anand.

Additional information

The authors gratefully acknowledge grant support from National Institute for Child Health and Human Development (NIH grants U10-HD50009 and R01-HD36484 to K.J.S.A.) and ZonMw 940-31-086, 940-39-004 (to D.T.) and the help of J.M. Tilford, Ph.D. for PRISM analyses.

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Cheung, C.L.S., van Dijk, M., Green, J.W. et al. Effects of low-dose naloxone on opioid therapy in pediatric patients: a retrospective case-control study. Intensive Care Med 33, 190–194 (2007). https://doi.org/10.1007/s00134-006-0387-z

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  • DOI: https://doi.org/10.1007/s00134-006-0387-z

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