Treatment of intrathecal morphine-induced pruritus following Caesarean section

Abstract

FRCPCPurpose: To compare both the efficacy and cost of nalbuphine and diphenhydramine in the treatment of intrathecal morphine-induced pruritus following Caesarean section. Methods: Eighty patients, undergoing elective Caesarean section under spinal anaesthesia, were randomized, in a prospective, double-blind trial, to receive either nalbuphine (Group NAL) or diphenhydramine (Group DIP) for the treatment of SAB morphine-induced pruritus. All patients received an intrathecal injection of 1 0-12 mg hyperbaric bupivacaine 0.75% and 200 ~tg preservative free morphine. Postoperative pruritus was assessed, using a visual analogue scale (VAS), for 24 hr. Pruritus treatment was administered upon patient request and by a nurse blinded to the treatment given. Patients who failed to respond to three doses of the study drug were deemed treatment failures. Patient satisfaction was assessed with a questionnaire given 24 to 48 hr after surgery. Direct drug costs were calculated based on the pharmacy provision costs as of April 1996. Results: Eighty patients were enrolled and 45 requested treatment for pruritus. Patients treated with NAL (n = 24) were more likely to achieve a VAS score of zero with treatment (83% vs 43%, P < 0.01), had a higher AVAS following treatment (4 + 2 vs 2 ___ 2, P < 0.003), and experienced fewer treatment failures (4% vs 29%, P < 0.04), than those treated with DIP (n = 21 ). Group NAL patients were also more likely to rate their pruritus treatment as being good to excellent (96% vs 57%, P < 0.004). Direct drug costs were higher for NAL than for DIP ($6.4 +_ 3. I vs $1.7 _+ 0.7, respectively, P < 0.0001). Conclusion: Nalbuphine is more effective than diphenhydramine in relieving pruritus caused by intrathecal morphine and the cost differences are small.Objectif : Comparer I'efficacit~ et le cofit de la nalbuphine avec ceux de la diphenhydramine administr6e apr& la c&arienne comme traitement du prurit provoqu~ par la morphine sous-arachndfdienne. M&hodes : Dans cette 6tude prospective en double aveugle, 80 parturientes op6r6es pour une c&arienne non urgente sous rachianesth&ie ont ~t~ r6parties au hasard pour recevoir comme traitement du prurit provoqu6 par la morphine soit de la nalbuphine (groupe NAL), soit de la diphenhydramine (groupe DIP). Toutes les patientes ont re~u une injection sous-arachndidienne de 10-12 mg de bupivac~'ne 0,75% hyperbare avec 200/~g de morphine sans pr&ervatif. Une &helle visuelle analogique (EVA) a servi ~ 6valuer I'intensit~ du prurit postop&atoire pendant 24 h. Le traitement antiprurigineux a &6 administr6 ~ la demande de la patiente et par une inflrmi&e ignorant la nature du traitement. On consid&ait le traitement comme un &hec en I'absence de r6ponse ~trois doses de la drogue &udi&. La satisfaction de la patiente &ait ~valu& avec un questionnaire administr~ 24 ~ 48 h apr& la chirurgie. Les coots d'approvisionnement de la pharmacie en avril 1996 repr~sentaient les coots directs des produits utilis&. R~sttltats : Quarante-cinq des 80 participantes ~ I'&ude ont demand~ un t...

Prevention of postoperative nausea and vomiting after intrathecal morphine for cesarean section: a randomized comparison of dexamethasone, droperidol, and a combination

“…Nevertheless, antihistamines are widely used for pruritus and can be an effective treatment, possibly because of the sedative effect. 31 In our study, intravenous diphenhydramine was used to treat pruritus, but it did not alleviate it.…”

Ondansetron for treatment of intrathecal morphine-induced pruritus after cesarean delivery

“…7,8 Pruritus is often difficult to treat and responds poorly to conventional treatment except for naloxone and nalbuphine. [9][10][11] Recently there has been evidence that opioids and serotoninergic systems interact closely in the central nervous system, with serotonin (5-HT) playing a role in both pain transmission and the induction of nausea via the 5-HT 3 receptor. 12 It has been postulated recently that 5-HT 3 receptors may have a role in the induction of pruritus after spinal morphine administration.…”

Définitions de la “dépression respiratoire” de l’analgésie postopératoire réalisée avec de la morphine intrathécale : une revue documentaire

“…Many defined RD with a RR less than 10. 40 This method is simple, non-invasive, and the patient is not inconvenienced. 104 While defining RD with bradypnea is superior to no definition whatsoever, it is considered to be an inadequate index of ventilatory depression.…”