An Update on Neuraxial Opioid Induced Pruritus Prevention

doi:10.15406/jaccoa.2016.06.00226

Cited by 6 publications

(4 citation statements)

References 47 publications

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“…The μ-1 receptor is responsible for analgesia. The adverse effects of intrathecal opioid pruritus, nausea, vomiting and shivering are mediated by the µ-2 opioid receptor (22,23,24) .…”

Section: Discussionmentioning

confidence: 99%

Influence of Low Dose Intrathecal Naloxone on Bupivacaine - Fentanyl Spinal Anaesthesia for Lower Limb Orthopedic Surgery in Elderly Patients

ElBendary¹,

Elhawary²,

Makharita³

et al. 2022

The Egyptian Journal of Hospital Medicine

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Background: Fentanyl as an adjuvant in spinal anesthesia is known to potentate postoperative analgesia. However, its adverse effects decrease patient satisfaction. Objectives: This study evaluated the effect of adding low-dose intrathecal naloxone to bupivacaine-fentanyl spinal anesthesia on the incidence of pruritus. Patients and Method: In total, 92 patients who underwent lower limb orthopedic surgery under spinal anesthesia were randomly allocated into two equal groups. In the bupivacaine-fentanyl (BF) group, patients received spinal anesthesia with 12.5 mg hyperbaric bupivacaine 0.5% plus 25 µg fentanyl, whereas in the bupivacaine-fentanyl-naloxone (BFN) group, 12.5 mg hyperbaric bupivacaine 0.5% plus 25 µg fentanyl and 20 µg naloxone was administered. Postoperative Mini-mental state examination (MMSE), arterial blood gas analysis, analgesia, and sedation were recorded postoperatively. Results:The incidence of postoperative pruritus and other fentanyl-induced side effects was significantly lower in the BFN group than in the BF group in the first 4 hours postoperatively. The onset of sensory and motor blockade was not statistically significant between the two groups. In the BFN group, the duration of sensory blockade, motor blockade, postoperative analgesia, and the total postoperative analgesic requirements with no significant difference in MMSE scores between the two groups. Conclusions: The addition of low-dose naloxone to intrathecal BF in lower limb orthopedic surgeries in older adults is associated with fewer incidences of fentanyl-induced side effects and more analgesic efficacy with no influence on cognitive function.

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“…The μ-1 receptor is responsible for analgesia. The adverse effects of intrathecal opioid pruritus, nausea, vomiting and shivering are mediated by the µ-2 opioid receptor (22,23,24) .…”

Section: Discussionmentioning

confidence: 99%

Influence of Low Dose Intrathecal Naloxone on Bupivacaine - Fentanyl Spinal Anaesthesia for Lower Limb Orthopedic Surgery in Elderly Patients

ElBendary¹,

Elhawary²,

Makharita³

et al. 2022

The Egyptian Journal of Hospital Medicine

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“…3 The exact mechanism of pruritus induced by IT morphine is not clear and many mechanisms like cephalad migration of morphine towards the itch centre in the central nervous system (CNS), antagonism of inhibitory transmitters and modulation of serotonergic pathway are involved. 3,4 Nalbuphine, an opioid agonist antagonist can suppress itch by its antagonist action on mu opioid receptors and agonist action on spinal kappa opioid receptors. Nalbuphine is superior to all other pharmacological agents and has been suggested as the first line of management for IT morphine-induced pruritus.…”

Section: Introductionmentioning

confidence: 99%

Randomized Double-Blind Trial Comparing Efficacy of Intravenous Nalbuphine vs Intrathecal Nalbuphine for Prevention of Intrathecal Morphine Induced Pruritus in Orthopaedic Surgeries

Kurhekar,

Krishna

2023

Sri Lankan J Anaesthesiol

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Intrathecal morphine provides excellent postoperative pain relief but results in pruritus in 30-60% of patients. Nalbuphine, an opioid agonist-antagonist prevents intrathecal morphine-induced itch when given by intravenous route. In this study, we compared efficacy of intrathecal and intravenous nalbuphine for the prevention of intrathecal morphine-induced pruritus. 90 patients were randomly divided into two groups. IT group received 100 mcg of morphine with 400 mcg of nalbuphine intrathecally. IV group received 100 mcg of morphine intrathecally and 400 mcg of nalbuphine intravenously. Incidence of itching, respiratory depression, hypotension, nausea, vomiting, sedation and analgesia were compared between the groups every 4th hourly for 24 hours. Data were analyzed with Chi-square test and Mann-Whitney test. Incidence of itching in 24 hours period was 11.6% (5 patients) in IV group and 4.8% (2 patients) in IT group which was comparable. (P= 0.250) Two patients in IV group had intractable itching requiring naloxone. Incidence of itching at all time intervals was comparable between the groups. Analgesia was prolonged in IV group (P=0.03) Incidence of nausea, vomiting, sedation and respiratory depression was comparable. We conclude that intrathecal nalbuphine and intravenous nalbuphine were equally effective in preventing intrathecal morphine induced pruritus. The duration of analgesia was more when nalbuphine was given by IV route as compared to IT route.

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“…The added bene ts of using ITM are that it is simple to administer, it is not associated with increase in blood loss during surgery and has longer duration of action (3). It is cost effective as it leads to early mobilization and decrease hospital stay (2,4,5).…”

Section: Introductionmentioning

confidence: 99%

The Use Of Intrathecal Morphine For Acute Postoparative Pain In Lower Limb Arthroplasty Surgery: A Survey Of Practice At An Academic Hospital.

Sibanyoni

Biyase

Chakane

2022

Preprint

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Background and purpose of the study: Intrathecal morphine (ITM) provides optimal postoperative analgesia in patients who are scheduled for total knee and hip operation with spinal anaesthesia. However, the ideal dose at which maximal analgesic effect occurs with minimal side effects is not known. This study aimed to describe the use of two doses of ITM, and side effect profile in patients undergoing elective hip and knee arthroplasty.Methods: This was a prospective, descriptive, and contextual study conducted on patients who had total hip and knee replacement at Chris Hani Baragwanath Academic Hospital from 1 September to 30 November 2020. The sample size consisted of 66 patients who were 18 years and older, American Society of Anaesthesiology (ASA) classification 1-3, patients who had received either 100 mcg or 150 mcg ITM dose under spinal anaesthesia and sent to the ward postoperatively. Visual Analogue Scale (VAS) score was used to assess pain in the first 24 hours, consumption of rescue analgesia and reported side effects were documented.Results: There was no relationship between age, weight, ASA classification or type of surgery and VAS score classification groups. Patients who received 100 mcg ITM had a higher median VAS pain score 2 (1-5) compared to those who received 150 mcg ITM 1 (0-2), p = 0.01. The need for rescue analgesia between the two groups was marginally less in the 150mcg ITM group (p =0.098). There was no difference in the rate of side effects between the 100 mcg ITM group [12 (41%)] and the 150 mcg ITM group [17 (59%)], p = 0.92. Rescue analgesia was marginally different between groups, p = 0.09. There were no real differences in the VAS pain scores between the total knee and total hip surgeries. None of the patients experienced clinically significant respiratory depression. Conclusion: The 150mcg ITM dose provided good analgesic effects with longer duration of action and comparable side effect profile to the 100mcg ITM dose. This dose was not associated with development of respiratory depression can therefore be administered safely to patients who are discharged to the ward postoperatively in a resource constraint environment.

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An Update on Neuraxial Opioid Induced Pruritus Prevention

Cited by 6 publications

References 47 publications

Influence of Low Dose Intrathecal Naloxone on Bupivacaine - Fentanyl Spinal Anaesthesia for Lower Limb Orthopedic Surgery in Elderly Patients

Influence of Low Dose Intrathecal Naloxone on Bupivacaine - Fentanyl Spinal Anaesthesia for Lower Limb Orthopedic Surgery in Elderly Patients

Randomized Double-Blind Trial Comparing Efficacy of Intravenous Nalbuphine vs Intrathecal Nalbuphine for Prevention of Intrathecal Morphine Induced Pruritus in Orthopaedic Surgeries

The Use Of Intrathecal Morphine For Acute Postoparative Pain In Lower Limb Arthroplasty Surgery: A Survey Of Practice At An Academic Hospital.

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