Comparison of Side Effects of Nalbuphine and Morphine in the Treatment of Pain in children with Cancer: A Prospective Study

Abstract

Contemporary pain management regimens in children do not include the use of the middle step of the analgesic ladder, i.e., weak opioids. The aim of this study was to analyse the comparison of side effects and the therapeutic efficacy of morphine and nalbuphine in pain management in children with cancer. We conducted an observational, prospective study and analysed medical records of patients treated at the Clinic of Paediatric Haematology and Oncology of the University Hospital in Wroclaw (Poland), who developed mucositis during treatment. The efficacy and safety of both drugs were analysed, and the efficacy of pain relief and the incidence of adverse effects characteristic of opioid drugs were compared. The cases of 96 of children treated with opioid drugs nalbuphine or morphine were analysed. Nalbuphine therapy was accompanied by a statistically significantly lower incidence of side effects such as skin pruritus, constipation, and micturition disorders compared to morphine (p < 0.05). After the discontinuation of nalbuphine, signs of withdrawal syndrome were much less frequent than after morphine (p < 0.05). In Conclusion, nalbuphine used as a pain killer in children with oncological disorder is a safe drug. It provides stable analgesia in most children. Compared to morphine, the side effects typical of opioid use are less common, and the incidence decreases over time.

Synthesis, structure, in vitro pharmacology, and in vivo activity of trans‐3,4‐dichloro‐N‐[[1‐(dimethylamino)‐4‐phenylcyclohexyl]methyl]‐benzamide (AP01; 4‐phenyl‐AH‐7921), a novel mixed μ‐/κ‐opioid

“…The “fear” and “tail sensitivity” differences may relate to the μ‐ versus κ‐opioid receptor selectivity for AP01 versus morphine, but this would only be speculation. Known MOR‐mediated side effects of morphine are constipation and decrease in frequency of urination [20], but that does not explain the absence of these effects observed with AP01. While it might have been desirable to test a range of doses to determine a therapeutic index, further studies were not warranted as the potential for toxicity based on the affinity for the serotonin transporter (SERT) along with the above mentioned in silico prediction that the compound may be an hERG blocker was enough to make a no‐go decision for further evaluation of any therapeutic potential or relative harm compared with therapeutically used opioids.…”

Construction of novel potentiometric sensors modified with biogenically synthesized metal oxide nanoparticles for sensitive detection of the opioid agonist-antagonist nalbuphine hydrochloride in its injection

“…In addition, nalbuphine's strong antagonistic effects make it less attractive as a substitution agent for heroin addicts or opioid users with high tolerance [ 53 ]. According to some anecdotal reports, nalbuphine is abused by health professionals and bodybuilders [ 54 ].…”

The Maxillary Nerve Block in Cleft Palate Care: A Review of the Literature and Expert’s Opinion on the Preferred Technique of Administration

“…5 Since cleft surgeries are generally very painful procedures, 2,3,6 morphine is routinely used in the Amsterdam UMC after cleft palate repair in pediatric patients. Nevertheless, reasons to strive to limit morphine use in young children are postoperative sedation, nausea, vomiting, and respiratory depression, [6][7][8][9] to which infants are more sensitive compared to older children or adults. 8 Literature has shown the maxillary nerve block (MNB) to be an effective addition to pain management in children undergoing cleft palate repair.…”