Prophylactic Oral Naltrexone With Intrathecal Morphine for Cesarean Section

Abboud, T. K.; Lee, K.; Chai, Miha; Zhu, Junwu; Afrasiabi, A.; Mantilla, M.; Steffens, Z.; Edwards, Sherita; Dhillon, Mandeep S

doi:10.1097/00000542-198909001-00836

Cited by 5 publications

(8 citation statements)

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“…Droperidol has also been reported to reduce epidural morphine-induced pruritus when administered either by the intravenous [10] or the epidural [11] route, although similarly its mode of action is likely to be due to sedation. It is possible to abolish spinal opioid-induced itch by naloxone, the specific opiate receptor antagonist [12,13] and also by the administration of opioid agonist/antagonist drugs such as nalbuphine [14], buprenorphine [15] and naltrexone [16]. The two patients in our study who received 0.4 mg of naloxone for persistent troublesome itching did not derive any benefit; it is possible that this was too small a dose.…”

Section: Discussionmentioning

confidence: 75%

“…Compared to an ICU the costs after initial outlay are likely to be modest [16] but as the demand increases these will rise [4]. The major cost is in nursing provision and it is difficult to match nurse staffing with bed occupancy although the high usage for elective surgery may make this more predictable than ICU staffing.…”

Section: Discussionmentioning

confidence: 99%

“…Whether or not an HDU can alter this is impossible to know and, in any case, some patients are deliberately discharged to permit a more natural terminal stage. However, it would seem that there must be room for improvement in the expected to live group [14,15].Compared to an ICU the costs after initial outlay are likely to be modest [16] but as the demand increases these will rise [4]. The major cost is in nursing provision and it is difficult to match nurse staffing with bed occupancy although the high usage for elective surgery may make this more predictable than ICU staffing.…”

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confidence: 99%

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The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for Caesarean section

Warwick

Kearns²,

Scott³

1997

Anaesthesia

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SummaryAll admissions into a six-bedded intensive care unit were audited prospectively over a 2-month period. Data were collected daily and classified according to criteria for intensive care or highdependency admission. There were 30 planned admissions (72 bed days) following elective major surgery, seven admissions following semi-elective surgery (41 bed days) and 47 emergency admissions (185 bed days). Overall bed occupancy was 89%. Of 366 possible intensive care days, 66 (23%) were occupied by high-dependency patients. Of the planned admissions all but five were discharged within 2 days. There were 39 major complications during the study period requiring life-saving interventions and 16 lesser but significant complications. In 12% of patients discharge was delayed because of the absence of a high-dependency unit. Four patients were transferred to an intensive care unit in another hospital and four patients were discharged prematurely because other patients required urgent admission. Seven patients were refused admission and three patients scheduled for elective operations had their surgery deferred. We estimate that over the study period 22 additional patients could have been cared for if a high-dependency unit existed. The suggestion that high-dependency units will solve some of the shortages created by lack of intensive care beds [1][2][3] is unproven. It appears that high-dependency provision significantly reduces the rate of cancellation of major elective surgery [4] and one report suggests a 13% reduction in mortality in the year following its introduction [5]. A high-dependency unit also provides a useful intermediate facility where more complex therapy and monitoring can be provided safely and efficiently [6]. KeywordsWe audited all admissions to our general intensive care unit prospectively over a 2-month period to estimate demand for high-dependency care. MethodThe type of patient (intensive care or high dependency) was recorded daily according to the criteria for admission described by (Appendix). Every patient occupying an intensive care unit (ICU) bed was evaluated at 10 a.m. each day over a 2-month period and classified as requiring an ICU or high-dependency unit (HDU) bed. Although the unit has six beds it was possible to admit more patients than there were beds due to transfers or deaths in the preceding 24-h period. The data collected daily included the patient's name, age, sex, diagnosis, operation (where relevant), complications in the last 24 h, length of stay and ICU outcome. Hospital outcome was determined after completion of the study. We also collected details on the number of ICU transfers in and out of the unit, elective surgical cancellations, refusals for admission to ICU and requests for admission to HDU. FacilitiesThe hospital has a six-bed general ICU which forms the basis for this study. There is also a three-bed liver HDU, a six-bed thoracic HDU, a nine-bed cardiac adult ICU and a six-bed cardiac HDU; these units are not under our direct ResultsThere were 84 admissions in th...

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for Caesarean section

Warwick

Kearns²,

Scott³

1997

Anaesthesia

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“…[12][13][14] For example, naltrexone was more effective than placebo in reducing the incidence of pruritus (reduction of 34% to 62%), but this drug also decreases analgesia. 15,16 Studies of nalbuphine in adults have generated conflicting data: some studies reported no reduction in pruritus, 13,17 whereas others showed a lower incidence of pruritus with nalbuphine than with placebo (13% versus 78%, respectively) 18 and lower pruritus scores (by 1 to 2 points on a 4-point scale).…”

Section: Introductionmentioning

confidence: 99%

Compatibility and Stability of Morphine Sulphate and Naloxone Hydrochloride in 0.9% Sodium Chloride for Injection

Kistner

Ensom

Decarie

et al. 2013

CJHP

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“…Naltrexone (NLT) (Revia'"), an opiate receptor antagonist that can be administered orally, is being used in the treatment of opioid and alcohol dependence. For patients with cholestatic liver disease or dialysis patients with severe intractable itching refractory to regular antipruritic therapy, oral NLT may be an effective and well-tolerated alternative (1,4,(6)(7)(8). Usually, uraemic patients develop pruritus before starting dialysis.…”

Section: Introductionmentioning

confidence: 99%

Pharmacokinetics and dialysability of naltrexone in patients undergoing hemodialysis

Kambia

Dine

Odou³

et al. 2004

European Journal of Drug Metabolism and Pharmacokinetics

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The disposition of naltrexone (NLT) (REVIA), an opioid antagonist intended for patients with impaired renal function and with severe intractable itching refractory to regular antipruritic therapy, was characterized. Hemodialysis effects on both efficacy and elimination of NLT also were assessed. We developed a simple, sensitive and selective reverse-phase high-performance liquid chromatographic (HPLC) method for measuring NLT plasma concentration in hemodialysis patients treated to relieve pruritus. NLT and the internal standard, naloxone (NLX) were extracted from plasma using a solid-phase extraction method with sep-pack C18 cartridge. The method was employed to determine both naltrexone pharmacokinetics and dialysability parameters during 4-h in dialyzed patients with chronic renal impairment. Thus, seven patients (2 men, 5 women) with end-stage renal disease and pruritus on regular hemodialysis were included. They received one tablet of NLT (Revia, 50 mg) orally prior dialysis session. The Cmax at the inlet and at the outlet the dialyzer were higher (255+/-117 ng/mL and 206+/-137 ng/ml respectively) in comparison with healthy subjects (9 - 44 ng/mL). The decrease hepatic first-pass metabolism of NLT consecutive to end-stage renal disease and the renal impairment could explain the increased levels of the drug in plasma. Tmax before and after dialysis plates remain unchanged as healthy subjects (approximately 1h). With regard to dialysability, a high dialyzer extraction ratio averating 30 % was found with a low dialysis clearance of 58.70+/-17 mL/min. The amount removed by dialysis is only 1.27 mg. We concluded that hemodialysis has little effect on NLT blood levels, and consequently on drug pharmacokinetics, when the drug is delivered to dialyzed patients following oral route. Thus, dosage adjustement is not required in the presence of advanced dialysis-dependant renal failure. In patients with end-stage renal disease, hemodialysis does not result in clinically significant alterations in the disposition of NLT. Post-dialysis supplementation is not required. These data suggest that there is no pharmacokinetic basis for modification of the initial dosage, but in view of NLT plasma concentration levels in the patients, a clinician could determine whether dosage adjustment are necessary and, if so, make the required calculations accurately.

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Prophylactic Oral Naltrexone With Intrathecal Morphine for Cesarean Section

Cited by 5 publications

References 0 publications

The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for Caesarean section

The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for Caesarean section

Compatibility and Stability of Morphine Sulphate and Naloxone Hydrochloride in 0.9% Sodium Chloride for Injection

Pharmacokinetics and dialysability of naltrexone in patients undergoing hemodialysis

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