Incidence and risk factors for epidural morphine induced pruritus in parturients receiving cesarean section

Abstract

This study is designed to clarify the incidence of epidural morphine induced pruritus (EMIP) in Chinese Han and Tibetan parturients after cesarean section (CS) and to identify the correlated risk factors.This is a prospective multicenter observational study. Follow-up evaluations were performed at 3 hours, 6 hours, 12 hours, 24 hours, and 48 hours after morphine administration. The primary outcome was EMIP incidence. Other details were also recorded for risk factor screening.Totally 284 parturients receiving CS were enrolled and 247 completed the study. The overall incidence of EMIP was 18.6% (46 in 247). The onset of pruritus was 5.6 ± 4.8 hours (mean ± SD) after morphine administration and the duration of pruritus was 14.0 ± 8.8 hours. Logistic regression models was built with 5 variables, history of allergy, serotonin receptor antagonist administration, I.V. fentanyl administration, epidural morphine volume and VAS pain score. Results of showed that 2 of the variables, history of allergy (P < .001) and serotonin receptor antagonist (P < .05), were significantly correlated with incidence of EMIP.In conclusion, EMIP incidence in our study was 18.6%. Positive medical history of allergy and not using serotonin receptor antagonist were potential risk factors of EMIP development.Trial registration: ChiCTR-OPC-17012345

The effect of epidural magnesium sulphate on postoperative nociception and serum B endorphin levels in high tibial osteotomy orthopedic surgery

“…[29] The potentiation of epidural analgesia when magnesium is used as adjuvant has been described in several reports. [30][31][32] In our study, patients who received magnesium sulphate during the operation showed to have less postoperative pain compared with patients who did not. These observations are in accordance with prior studies results on the analgesia-potentiating effect of magnesium.…”

Rashes following cesarean delivery: a case report

“…Pruritus may occur 5.6±4.8 hours after the administration of morphine and can last for 14.0±8.8 hours. Also, Pettini et al (12) and Tan et al (13) reported a history of allergies is a potential risk factor for pruritus caused by morphine. Studies by Pettini et al (12) and Aly et al (14) have shown that serum serotonin levels are significantly increased in patients after cesarean section, and the absence of serotonin receptor antagonists is also a potential risk factor for pruritus.…”

Comparative evaluation of epidural bupivacaine alone and bupivacaine combined with magnesium sulfate in providing postoperative analgesia: a meta-analysis of randomized controlled trials

“…Nevertheless researchers continue to find the optimum adjuvants, as the currently researched adjuvants (e.g. opioids, tramadol, dexmedetomidine) still have some adverse effects such as nausea and vomiting, pruritus, bradycardia, and hypotension [4][5][6].…”