Postoperative itching is an important problem in the postoperative care unit. Pruritus after surgery may be drug induced (including intrathecal opioids) or secondary to a preexisting systemic disease. Mechanisms of itching are complex and not completely understood. The purpose of this review is to highlight new discoveries in pathways and mechanisms of pruritus and to summarize up-to-date knowledge about treatment of itching after surgery. More basic and clinical studies are needed to address the effects of drugs on specific receptors and improve the treatment of postoperative pruritus.

Aprotinin is an important member of a family of related protease inhibitors and has many clinically beneficial activities. These inhibitors have multiple functions, but not all of them are mediated by enzyme inhibition. Aprotinin has complex effects on many homeostatic functions including coagulation, platelet function and inflammation. It also has complex interactions with other drug therapies including angiotensin-converting enzyme inhibitors. Since patients with cardiovascular diseases are treated frequently with angiotensin-converting enzyme inhibitors and also often need cardiopulmonary bypass surgery and receive aprotinin, these interactions are potentially significant but often overlooked. Aprotinin is currently used to reduce the amount of transfused homologous blood (during cardiopulmonary bypass surgery) and thus, the risks associated with homologous blood transfusion. Aprotinin also has potential uses in acute pancreatitis, carcinoid tumors, sepsis, and other clinical situations. Future research will provide a definitive answer for the need to employ this inhibitor therapeutically in these situations. Aprotinin also has some potentially adverse effects in the kidney in special circumstances. For example, the use of aprotinin in diabetic patients may be related with an increased risk for renal dysfunction. It has also been associated with thrombosis, inadequate coagulation, and allergic reactions. In balance, the available information indicates that the advantages of its application outweigh its disadvantages in most patients.

P Pu ur rp po os se e: : A short recovery time for same day surgery is important to the patient and the hospital. A prospective, randomized, doubleblinded study in the postanesthetic care unit was designed to compare the recovery time from spinal anesthesia with low-dose intrathecal (IT) lidocaine and sufentanil to that with IT lidocaine alone. The incidence of adverse effects was also assessed.M Me et th ho od ds s: : Forty-nine patients (ASA I-III, age 20-69 yr) underwent spinal anesthesia for rectal surgery. The patients were randomized into two groups. One group (n = 28) received low-dose IT lidocaine (15 mg) and sufentanil (10 µg) and the other group (n = 21) received IT lidocaine (50 mg). The time to ambulation, the incidence of pruritus, and other variables were recorded. Statistical difference was assumed if P < 0.05.

P Pu ur rp po os se e: : Postoperative itching after intrathecal (IT) narcotics may be a difficult and important problem for both the anesthesiologist and the patient in the postanesthetic care unit. Since some studies have reported success in preventing itching with ondansetron, we designed a prospective, randomized, double-blinded, and controlled study to test whether prophylactic iv ondansetron effectively reduces the incidence of IT sufentanil-induced pruritus.M Me et th ho od ds s: : Thirty-four patients (ASA I-III, age 18-74 yr) underwent ambulatory surgery after spinal anesthesia with IT lidocaine (15-100 mg) and IT sufentanil (10 µg). The patients were randomized into two groups to receive iv either 4 mL saline (n = 13) or 8 mg ondansetron (n = 21) before the IT injection. The incidence of pruritus and other variables was recorded. Pruritus scores were obtained with a verbal analogue score with 0 meaning none and 10 the worst itching that the patient could imagine. Statistical difference was assumed if P < 0.05. R Re es su ul lt ts s: : Ondansetron did not reduce the incidence of pruritus (77 vs 81%) compared to placebo (P = 1.000). The pruritus scores (4.4 vs 3.6) of the two groups were not significantly different (P = 0.670).C Co on nc cl lu us si io on ns s: : There are contradictory findings in the literature regarding the effectiveness of ondansetron in preventing narcoticinduced itching. Although some studies have indicated that ondansetron could prevent this side effect of IT narcotics, a recent report suggested that ondansetron is not effective in preventing narcotic-induced itching (sufentanil-morphine) after a Cesarean section. In the present study we obtained similar, negative results. Objectif : Le prurit postopératoire induit par l'administration intrathé-cale (IT) de narcotiques est un problème important pour l'anesthésio-logiste et le patient en salle de réveil. Certaines études ont montré que l'ondansétron prévenait le prurit. Notre étude prospective, randomisée, contrôlée et à double insu voulait vérifier si l'administration iv préventive d'ondansétron réduit effectivement l'incidence de prurit induit par le sufentanil IT. Méthode : Trente-quatre patients (ASA I-III, de 18 à 74 ans) ont subi une intervention chirurgicale ambulatoire sous rachianesthésie avec de la lidocaïne IT (15-100 mg) et du sufentanil IT (10 µg). Les patients, randomisée en deux groupes, ont reçu soit 4 mL de solution saline iv (n = 13), soit 8 mg d'ondansétron (n = 21) avant l'injection IT. L'incidence de prurit et d'autres variables a été notée. Les scores de

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