Intrathecal fentanyl-induced pruritus is more severe in combination with procaine than with lidocaine or bupivacaine

Mulroy, Michael F.; Larkin, Kathleen L.; Siddiqui, Afreen

doi:10.1053/rapm.2001.22997

Cited by 14 publications

(7 citation statements)

References 27 publications

(21 reference statements)

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“…Among all the side effects of intrathecal opioids, pruritus (50 -75%) was most common. This corroborates with a recent study 46 which reported a higher incidence of pruritus with knee arthroscopy than other surgical patients, and pruritus further increased with the use of bupivacaine rather than lignocaine. The increased pruritus can be a disadvantage in day care patients in whom anaesthetic management is tailored to reduce side effects.…”

Section: Discussionsupporting

confidence: 92%

Systematic review of spinal anaesthesia using bupivacaine for ambulatory knee arthroscopy

Nair

Abrishami

Lermitte

et al. 2009

British Journal of Anaesthesia

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The use of lidocaine in spinal anaesthesia is associated with transient neurological syndrome (TNS). Bupivacaine has a lower incidence of TNS as an alternative but it may have a prolonged action. This study systematically reviews the literature about the recovery profile of patients undergoing spinal anaesthesia, using bupivacaine for arthroscopic knee surgery. We identified 17 eligible randomized clinical trials (RCTs) (1268 patients). All the articles in this review, except one, used hyperbaric bupivacaine. Five trials compared different doses of bupivacaine (range 3-15 mg). Large doses of bupivacaine (10 and 15 mg) were associated with delayed recovery, and supine positioning was associated with a high incidence of failure. With unilateral positioning, a dose as low as 4-5 mg seems to be sufficient. Five trials comparing bupivacaine or levobupivacaine with ropivacaine showed no significant difference in the time to home discharge. When bupivacaine was combined with fentanyl in two trials, marginal delay in recovery was found [time to discharge (min); weighted mean difference (WMD) 14.1, 95% CI 11.9-40.1] and increased nausea and pruritus but had reduced postoperative pain. Unilateral and bilateral spinal anaesthesia were assessed in two trials, and the latter group was associated with early recovery and discharge [time to discharge (min); WMD 241.6, 95% CI 263.6 to 219.6). The results of our systematic review suggest that 4-5 mg of hyperbaric bupivacaine can effectively produce spinal anaesthesia for knee arthroscopy with unilateral positioning. Ropivacaine or the addition of adjuvants did not improve the recovery time. There is a need for tighter RCTs with more consistent endpoints.

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Section: Discussionsupporting

confidence: 92%

Systematic review of spinal anaesthesia using bupivacaine for ambulatory knee arthroscopy

Nair

Abrishami

Lermitte

et al. 2009

British Journal of Anaesthesia

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“…The commonest side‐effect seen in our study was pruritus, which occurred with a frequency of 50–60%; similar to the results of others (13,21). The other major cause for concern is urinary retention after bupivacaine and fentanyl intrathecally.…”

Section: Discussionsupporting

confidence: 92%

Low‐dose bupivacaine plus fentanyl for spinal anesthesia during ambulatory inguinal herniorrhaphy: a comparison between 6 mg and 7. 5 mg of bupivacaine

Gupta

Axelsson

Thörn

et al. 2002

Acta Anaesthesiol Scand

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“…[ 5 ] Intrathecal fentanyl administration is also associated with high incidence of pruritus in parturients. [ 6 7 8 ]…”

Section: Introductionmentioning

confidence: 99%

Comparison of epidural oxycodone and epidural morphine for post-caesarean section analgesia: A randomised controlled trial

et al. 2016

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Background and Aims:Epidural morphine after caesarean section may cause moderate to severe pruritus in women. Epidural oxycodone has been shown in non-obstetric trials to reduce pruritus when compared to morphine. We hypothesised that epidural oxycodone may reduce pruritus after caesarean section.Methods:A randomised controlled trial was conducted in pregnant women at term who underwent caesarean section with combined spinal-epidural technique initiated with intrathecal fentanyl 15 μg. Women received either epidural morphine 3 mg or epidural oxycodone 3 mg via the epidural catheter after delivery. The primary outcome was the incidence of pruritus at 24 h after caesarean section. The secondary outcomes were the pruritus scores, treatment for post-operative nausea and vomiting (PONV), pain scores and maternal satisfaction.Results:One hundred women were randomised (group oxycodone O = 50, morphine M = 50). There was no difference between Group O and M in the incidence of pruritus (n [%] 28 [56%] vs. 31 [62%], P = 0.68) and the worst pruritus scores (mean [standard deviation] 2.6 (2.8) vs. 3.3 [3.1], P = 0.23), respectively. Both groups had similar pain scores at rest (2.7 [2.3] vs. 2.0 [2.7], P = 0.16) and sitting up (5.0 [2.3] vs. 4.6 [2.4], P = 0.38) at 24 h. Pruritus scores were lower at 4–8, 8–12 and 12–24 h with oxycodone, but pain scores were higher. Both groups had a similar need for treatment of PONV and maternal satisfaction with analgesia.Conclusion:There was no difference in the incidence of pruritus at 24 h between epidural oxycodone and morphine. However, pruritus scores were lower with oxycodone between 4 and 24 h after surgery with higher pain scores in the same period.

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Intrathecal fentanyl-induced pruritus is more severe in combination with procaine than with lidocaine or bupivacaine

Abstract: Procaine produces a higher frequency of pruritus than that seen with lidocaine-fentanyl combinations and a greater severity of pruritus than seen with lidocaine-fentanyl and bupivacaine-fentanyl spinal anesthesia. Reg Anesth Pain Med 2001;26:252-256.

Cited by 14 publications

References 27 publications

Systematic review of spinal anaesthesia using bupivacaine for ambulatory knee arthroscopy

Systematic review of spinal anaesthesia using bupivacaine for ambulatory knee arthroscopy

Low‐dose bupivacaine plus fentanyl for spinal anesthesia during ambulatory inguinal herniorrhaphy: a comparison between 6 mg and 7. 5 mg of bupivacaine

Comparison of epidural oxycodone and epidural morphine for post-caesarean section analgesia: A randomised controlled trial

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