Comparative analysis of dexmedetomidine and nalbuphine for analgo-sedation in Pediatric Intensive Care Unit (PICU): a prospective cohort observational study

Abstract Introduction The primary aim of this study was to compare the analgesic and sedative effects of nalbuphine and dexmedetomidine administered as continuous infusions in critically ill pediatric patients of a tertiary care hospital. Methodology This prospective observational cohort study included children admitted to the PICU from December 2019 to November 2022 who received either dexmedetomidine or nalbuphine for analgo-sedation for more than 24 h. The primary outcomes were Sedation and Agitation Scale (SAS) and Face, Legs, Activity, Cry and Consolability (FLACC) scale scores. Propensity Score (PS) matching was used to estimate the treatment effects. The secondary aim of the study was to evaluate the safety profile, i.e., withdrawal score and hemodynamic effects of the two drugs. Results There was no significant difference in the estimated treatment effect (Average treatment effect on the treated [ATET]) for average FLACC score in both the groups (ATET 0.029 points, 95%CI -0.23 to 0.28; p = 0.82). However, the average SAS score in the dexmedetomidine group was slightly higher (ATET 0.44 points, 95%CI 0.006–0.884; p = 0.04) than in the nalbuphine group. Withdrawal symptoms were experienced by 20 (17.86%) patients in the nalbuphine group and 4 (3.9%) patients in the dexmedetomidine group within 72 h of post-infusion cessation, whereas bradycardia (aIRR 2.75; p-value 0.004) and hypotension (aOR 1.962; p-value 0.09) were more pronounced in the dexmedetomidine group than nalbuphine group. Conclusion Our study shows that the analgo-sedation profiles of dexmedetomidine and nalbuphine were equally comparable; however, dexmedetomidine provided adequate analgesia with lighter sedation and fewer iatrogenic drug withdrawals.