Opioid Antagonist Adjuncts to Epidural Morphine for Postcesarean Analgesia

Wittels, Bernard; Glosten, Beth; Faure, E; Moawad, Atef H.; Ismail, Mahmoud; Hibbard, Judith U.; Amundsen, Laurie B.; Binstock, Wendy; Senal, Jonathon A.; Cox, Susanne; Blackman, Samuel C.; Karl, Leah; Thisted, Ronald A.

doi:10.1097/00132586-199404000-00027

Cited by 10 publications

(19 citation statements)

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“…The addition of butorphanol to morphine in the range of doses tested in these trials did not increase the incidence of respiratory depression. Intravenous butorphanol increased the Ramsay sedation score at 24 hr 13 and the incidence of somnolence, 26 but epidural butorphanol did not cause any difference in the incidence of somnolence. Dizziness is a common side effect of butorphanol, 39 but our synthetic result indicated that butorphanol did not increase the incidence of dizziness.…”

Section: Discussionmentioning

confidence: 73%

“…Ultimately, 16 valid trials were analyzed with data for 795 patients, 452 of whom received butorphanol (Table 1). [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Four of these trials involved children \ 18 years of age. [21][22][23][24] The methodological quality of the included studies Ten of the 16 included trials 13,18,[20][21][22][23][24][25][26][27] provided a sequence generation for randomization.…”

Section: Study Selectionmentioning

confidence: 99%

“…[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Four of these trials involved children \ 18 years of age. [21][22][23][24] The methodological quality of the included studies Ten of the 16 included trials 13,18,[20][21][22][23][24][25][26][27] provided a sequence generation for randomization. Most trials did not show adequate information about the allocation concealment; 11 studies 12,13,18,[20][21][22][23][24][25][26][27] were double-blinded.…”

Section: Study Selectionmentioning

confidence: 99%

“…21,[24][25][26][27] Treatment was requested by 27.1% (39 in 144) of the patients in the epidural butorphanol group and by 46.7% (45 in 96) of the patients in the control group. Thus, prophylactic administration of epidural butorphanol significantly decreased the number of patients requesting curative treatment for pruritus (RR 0.57; 95% CI 0.41 to 0.81) (Fig.…”

Section: The Incidence Of Pruritusmentioning

confidence: 99%

“…[12][13][14][15]17,19,20,26,27 Data on pain scores at four, eight, 12, 24, and 48 hr following the operation were combined because several studies reported VAS pain scores at each of the above time points. At four, eight, and 12 hr, butorphanol decreased pain intensity with SMD -0.29 (95% CI -0.52 to -0.05), -0.30 (95% CI -0.56 to -0.04), and -0.23 (95% CI -0.46 to -0.01), respectively.…”

Section: Postoperative Pain Intensitymentioning

confidence: 99%

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Butorphanol prevents morphine-induced pruritus without increasing pain and other side effects: a systematic review of randomized controlled trials

Song

Wang

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Pruritus is a frequent adverse event after administration of morphine. Butorphanol has been used to prevent morphine-induced pruritus, but its efficacy is still controversial. The aim of this systematic review was to evaluate the efficacy of using butorphanol to prevent morphine-induced pruritus. Source We searched PubMed, Cochrane Library, EMBASE, and China's BioMedical Disc for full reports of randomized controlled trials that compared the use of butorphanol with either placebo or no treatment for preventing morphineinduced pruritus. The number of patients experiencing pruritus or other side effects was analyzed using relative risk (RR) with 95% confidence intervals (CI). Principal findings Sixteen trials (795 patients) were analyzed. Continuous intravenous and epidural butorphanol reduced pruritus with RR 0.22 (95% CI 0.10 to 0.45) and RR 0.24 (95% CI 0.16 to 0.36), respectively. Use of epidural butorphanol decreased the number of patients requesting rescue treatment for pruritus (RR 0.57; 95% CI 0.41 to 0.81). Butorphanol decreased postoperative pain intensity at four, eight, and 12 hr with standardized mean differences of -0.29 (95% CI -0.52 to -0.05), -0.30 (95% CI -0.56 to -0.04), and -0.23 (95% CI -0.46 to -0.01), respectively. Epidural but not intravenous butorphanol reduced postoperative nausea and vomiting (PONV) (RR 0.35; 95% CI 0.19 to 0.66). Butorphanol did not increase respiratory depression (RR 0.71; 95% CI 0.31 to 1.63), somnolence (RR 0.71; 95% CI 0.22 to 2.37), or dizziness (RR 2.45; 95% CI 0.35 to 17.14). Conclusion Butorphanol administered with morphine may be an effective strategy for preventing morphineinduced pruritus as it decreases pain intensity and PONV without increasing other side effects. Thus, it can be recommended for preventing morphine-induced pruritus during the perioperative period. RésuméObjectif Le prurit est un effet secondaire néfaste fréquent après l'administration de morphine. Le butorphanol a été utilisé pour prévenir le prurit induit par la morphine, mais son efficacité est encore controversée. L'objectif de cette revue méthodique était d'évaluer l'efficacité du butorphanol pour prévenir le prurit induit par la morphine.

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Section: Discussionmentioning

confidence: 73%

Section: Study Selectionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: The Incidence Of Pruritusmentioning

confidence: 99%

Section: Postoperative Pain Intensitymentioning

confidence: 99%

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Butorphanol prevents morphine-induced pruritus without increasing pain and other side effects: a systematic review of randomized controlled trials

Song

Wang

et al. 2013

Can J Anesth/J Can Anesth

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IV butorphanol reduces analgesia but not pruritus or nausea associated with intrathecal morphine

Sakai¹,

Fukano²,

Sumikawa³

2001

Can J Anesth/J Can Anesth

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Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine

Choi¹,

Lee²,

Choi³

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To determine whether epidural naloxone preserved analgesia while minimizing side effects caused by epidural morphine.Methods: Eighty patients undergoing combined epidural and general anesthesia for hysterectomy were randomly assigned to one of four groups. All received 2 mg epidural morphine bolus one hour before the end of surgery and a continuous epidural infusion was started containing 4 mg morphine in 100 ml bupivacaine 0.125% with either no naloxone (Group 1, n=20), 0.083 µg·kg of naloxone (Group 4, n=20). Analgesia and side effects were evaluated by blinded observers.Results: The combination of epidural morphine and bupivacaine provided good analgesia. Eight hours after the end of surgery, the pain score in the group receiving the highest dose of naloxone was lower than in the control group (VAS 1.2 vs 2.0, P < 0.05) but there was less pruritus in the high-dose naloxone group (itching score 1.3 vs 1.9, P < 0.05). Pain scores were no different in any of the naloxone groups from the control group. Itching was less in both of the higher dose naloxone groups (P < 0.05 at 8, 16, and 32 hours). The incidence of vomiting in the control group was 40% vs 5% for high dose naloxone group (P < 0.05).Conclusions: Epidural naloxone reduced morphine-induced side effects in dose-dependent fashion without reversal of the analgesic effect. Objectif Objectif :: Déterminer si la naloxone épidurale préserve l'analgésie tout en réduisant les effets secondaires de la morphine épidurale. Méthode Méthode :: Quatre-vingt patientes devant subir une hystérectomie avec une anesthésie péridurale et générale combinée ont été réparties au hasard en quatre groupes. Toutes ont reçu un bolus de 2 mg de morphine épidu-rale une heure avant la fin de l'opération et une perfusion épidurale continue a été amorcée avec 4 mg de morphine dans 100 ml de bupivacaïne 0,125 % sans naloxone (Groupe 1, n = 20), avec 0,083µg·kg -1 ·h -1 de naloxone (Groupe 2, n = 20), ou 0,125µg·kg : La combinaison de morphine épidurale et de bupivacaïne a fourni une bonne analgésie. Huit heures après la fin de l'intervention chirurgicale, le score de douleur chez les patientes qui ont reçu la plus forte dose de naloxone était plus bas que celui des patientes du groupe témoin (EVA 1,2 vs 2,0, P < 0,05), et il y avait moins de prurit chez les patientes ayant reçu la dose élevée de naloxone (score de 1,3 vs 1,9, P< 0,05). Les scores de douleur n'ont pas montré de différence intergroupe. Le prurit était moins marqué chez les patientes des deux groupes qui ont reçu les doses plus élevées de naloxone ( P < 0,05 à 8, 16, et 32 heures). L'incidence des vomissements chez les patientes témoins a été de 40 % vs 5 % pour les femmes ayant reçu une forte dose de naloxone P < 0,05).Conclusion : L'administration épidurale de naloxone réduit les effets secondaires induits par la morphine d'une façon qui dépend de la dose sans renverser l'effet de l'analgésique.

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Opioid Antagonist Adjuncts to Epidural Morphine for Postcesarean Analgesia

Cited by 10 publications

References 0 publications

Butorphanol prevents morphine-induced pruritus without increasing pain and other side effects: a systematic review of randomized controlled trials

Butorphanol prevents morphine-induced pruritus without increasing pain and other side effects: a systematic review of randomized controlled trials

IV butorphanol reduces analgesia but not pruritus or nausea associated with intrathecal morphine

Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine

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