Reduction of fentanyl-induced cough by low-dose nalbuphine pretreatment during induction of general anesthesia in children: a randomized controlled trial

Background Fentanyl-induced cough (FIC) during induction of general anesthesia is a common phenomenon and may cause adverse events. This study was designed to assess the efficacy and safety of low-dose nalbuphine pretreatment for the reduction of FIC in children. Methods One hundred patients aged 2–12 years, with American Society of Anesthesiologists (ASA) physical status I–II, scheduled for elective surgery under general anesthesia, were randomly allocated to the nalbuphine group (Group N) or the control group (Group C). Patients were assigned to receive either nalbuphine 0.02 mg/kg or an equal volume of 0.9% normal saline 2 min before fentanyl bolus (2 μg/kg, injected within 5 s). The primary outcome was the incidence of FIC during induction of general anesthesia. The secondary outcomes included the onset time and severity of cough. Vital signs and any adverse events were recorded during induction of general anesthesia. Results The incidence of FIC was significantly lower in Group N than in Group C (9/50 [18%] vs. 27/50 [54%]; risk difference, −36% (95% CI, −53% to −19%); P < 0.001). There was no significant difference between the two groups in the onset time of cough (Mann–Whitney U = 101.5, P = 0.460; r = 0.165, 95% CI, −0.173–0.468). Cough severity in Group N was statistically lower than that of Group C (Mann–Whitney U = 750, P < 0.001; r = 0.402, 95% CI, 0.223–0.554). No significant differences were observed in heart rate (HR), non-invasive blood pressure (NIBP) and oxygen saturation (SpO 2 ) between the two groups before or after fentanyl administration. No adverse events occurred during induction of general anesthesia in either group. Conclusion Low-dose nalbuphine 0.02 mg/kg significantly reduces the incidence of FIC during induction of general anesthesia in children.