Epidural-Morphine-Induced Pruritus

Abstract

In a prospective, randomized, double-blind clinical trial, we compared the efficacy of propofol and naloxone for the treatment of spinal-morphine-induced pruritus. Forty patients presenting with severe pruritus within 24 h of epidural morphine administration were allocated to receive either propofol 10 mg intravenously (i.v.) or naloxone 2 micrograms/kg. In the absence of a positive response, a second dose of the same treatment was given 5 min later. Pruritus and the level of post-operative pain were assessed every 5 min up to the end of the study period (45 min) using a verbal rating scale. The overall success rate in treating pruritus was similar in the two groups (80%). The rate of success after the first injection of the treatment drug was also similar (55%). The level of postoperative pain decreased after drug treatment in six patients (30%) in the propofol group versus none in the naloxone group (P < 0.05). Forty-five percent of the patients in the naloxone group had an increase in the level of postoperative pain versus none in the propofol group (P < 0.05). In conclusion, these results suggest that propofol and naloxone are equally effective in treating spinal-morphine-induced pruritus. However, the level of postoperative pain is significantly less in the propofol group.

Side‐effects of epidural infusions of opioid bupivacaine mixtures

“…The addition of adrenaline has been shown to increase the incidence of pruritis [50] and the use of propofol has been shown to reduce pruritis [51]. In this study no adrenaline was given and the use of intra-operative propofol sedation did not result in any reduction in the incidence of pruritis during the postoperative period.…”

Intracisternal Injection of Opioids Induces Itch-Associated Response through .MU.-Opioid Receptors in Mice.

“…was suppressed by naloxone. As mentioned above, itch ing following epidural morphine (3,6) and the pruritus of cholestasis (7-9) is inhibited by naloxone. Thus, the present results are consistent with the view that facial scratching induced by i.c.…”

“…Itching of humans given intrathecal or epidural opioids is inhibited by opioid antagonists (3,6). On the other hand, agitation responses, including scratching of the skin, of the rat induced by a high intrathecal dose of morphine are not inhibited by the opioid antagonist naltrexone (17).…”

“…Itching is the most common side effect of opioid anal gesics (1-3), but not narcotic agonist-antagonist anal gesics (4,5). The opioid-induced pruritus is inhibited by the opioid antagonist naloxone (3,6). Regarding pruritic diseases, the pruritus of cholestasis is ameliorated by opioid antagonists (7)(8)(9).…”

Subcutaneous naloxone for the prevention of intrathecal morphine induced pruritus in elective Caesarean delivery*

“…Naloxone, a competitive antagonist at opioid receptors, has been shown to be effective in treating or preventing the pruritus associated with intrathecal or epidural morphine [11][12][13][14][15]. Due to the short duration of action when administered intravenously, studies have involved intravenous regimes of naloxone infusions with or without loading doses [6,11,14,16].…”