Methylnaltrexone to prevent intrathecal morphine-induced pruritus after Caesarean delivery: a multicentre, randomized clinical trial

Paech, Michael J.; Sng, Ban Leong; Ng, Lee Ping; Nathan, Elizabeth; Sia, Alex Tiong Heng; Carvalho, Brendan

doi:10.1093/bja/aeu410

Cited by 20 publications

(12 citation statements)

References 34 publications

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“…Prophylactic treatment with a peripheral mu antagonist was ineffective for the treatment of intrathecal morphine-induced pruritus, although a small clinical effect should not be excluded [16]. Similar results were found in an orthopedic surgery study.…”

Section: Opioid Receptor Antagonistssupporting

confidence: 80%

Why do Pain Physicians Not Routinely Use Mixed Opioids for the Prevention of Neuraxial Opioid-induced Pruritus?

Bujedo¹

2017

TOPAINJ

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Section: Opioid Receptor Antagonistssupporting

confidence: 80%

Why do Pain Physicians Not Routinely Use Mixed Opioids for the Prevention of Neuraxial Opioid-induced Pruritus?

Bujedo¹

2017

TOPAINJ

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“…Prophylactic treatment with a peripheral mu antagonist was ineffective against the intrathecal morphine-induced pruritus in the peripartum period, although a small clinical effect could not be excluded [27]. In this regard, similar results were found in a study in orthopedic surgery.…”

Section: Prevention and Treatment Of Neuraxial Opioid Induced Pruritussupporting

confidence: 76%

An Update on Neuraxial Opioid Induced Pruritus Prevention

2016

JACCOA

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“…At 24 h after surgery, each subject was reviewed by a blinded investigator. The overall incidence of pruritus was determined and whether treatment for the pruritus was required by the subject; maternal satisfaction of pain relief and control of pruritus was recorded (0–100, 0 = totally unsatisfied and 100 = totally satisfied); treatment for post-operative nausea and vomiting (PONV) as requested by the subject; the QoR score;[ 13 ] and the overall benefit of analgesia score (OBAS, range 0–28)[ 14 ] were recorded. Direct questioning was used to assess the presence of side effects, the ability to breastfeed, pass wind, open bowels and presence of a urinary catheter.…”

Section: Methodsmentioning

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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Methylnaltrexone to prevent intrathecal morphine-induced pruritus after Caesarean delivery: a multicentre, randomized clinical trial

Abstract: Australian New Zealand Clinical Trials Registry (ACTRN12611000345987).

Cited by 20 publications

References 34 publications

Why do Pain Physicians Not Routinely Use Mixed Opioids for the Prevention of Neuraxial Opioid-induced Pruritus?

Why do Pain Physicians Not Routinely Use Mixed Opioids for the Prevention of Neuraxial Opioid-induced Pruritus?

An Update on Neuraxial Opioid Induced Pruritus Prevention

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

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