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Nalbuphine Reduces Opioid-Associated Urinary Retention in Pediatric Patients

Reiter, Pamela D., PharmD, BCCCP1,2; Clevenger, Amy C., MD, PhD3

Pediatric Critical Care Medicine: May 2019 - Volume 20 - Issue 5 - p e240–e244
doi: 10.1097/PCC.0000000000001920
Online Clinical Investigations

Objectives: To evaluate the effect of nalbuphine administration on urine output in critically ill children with opioid-associated urinary retention.

Design: Institutional review board approved, single center, retrospective medical chart review.

Setting: Large medical-surgical PICU within a free-standing, tertiary care children’s hospital.

Patients: Patients admitted to the PICU between October 1, 2014, and February 29, 2016, who received IV nalbuphine after meeting criteria for opioid-associated oliguria (defined as urine output below 1 mL/kg/hr and received at least one dose of opioid therapy within the preceding 12 hr).

Interventions: None.

Measurement and Main Results: Seventeen patients who received 21 doses of nalbuphine were analyzed. The median age and weight of patients were 6 years (interquartile range, 3–11.5 yr) and 18 kg (interquartile range, 12–35 kg), respectively. Two distinct dosing strategies became evident, specifically 0.05 mg/kg (n = 11 doses) and 0.1 mg/kg (n = 10 doses). Urine output increased significantly from baseline (median, 0 mL/kg/hr; interquartile range, 0–0.53 mL/kg/hr) to 6 hours post nalbuphine administration (median, 1.48 mL/kg/hr; interquartile range, 0–2 mL/kg/hr; p = 0.0002). Patients who received 0.1 mg/kg/dose had a greater urine output response compared with those who received 0.05 mg/kg/dose. Five patients (29%) had a catheter inserted into their bladder after administration of nalbuphine. Pain scores (grouped 6 hr before and after nalbuphine administration and single pain scores documented immediately before and after nalbuphine administration) were unchanged.

Conclusions: Nalbuphine administration, at a dose of 0.1 mg/kg, improved urine output in a cohort of children with opioid-associated urinary retention. Pain control did not appear influenced by the provision of nalbuphine. Additional studies are needed to determine the influence of nalbuphine on urinary catheter insertion rates and catheter-associated urinary tract infections.

1Department of Pharmacy and Division of Pediatric Critical Care, Children’s Hospital Colorado, Aurora, CO.

2Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Clinical Pharmacy, Anschutz Medical Campus, Aurora, CO.

3Department of Pediatrics, Division of Pediatric Critical Care, Children’s Hospital Colorado and University of Colorado Denver, Anschutz Medical Campus, Aurora, CO.

The authors have disclosed that they do not have any potential conflicts of interest.

This work was performed at Children’s Hospital Colorado, Anschutz Medical Campus, Aurora, CO.

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©2019The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies