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Efficacy of intramuscular nalbuphine versus diphenhydramine for the prevention of epidural morphine-induced pruritus after cesarean delivery.

AbstractBACKGROUND:
Pruritus is the most common side effect of epidural morphine analgesia. Diphenhydramine is a widely used agent for the treatment of urticarial pruritus. Nalbuphine is a mixed opioid agonist-antagonist and has been reported to be effective in treating opioid-induced pruritus. We compared the effectiveness of intramuscular diphenhydramine and nalbuphine for the prevention of epidural morphine-induced pruritus after cesarean section.
METHODS:
One hundred and fifty, American Society of Anesthesiologists physical status I or II, women undergoing cesarean section with epidural anesthesia were randomly assigned to three groups. Group S, group D, and group N received intramuscular normal saline (1 ml; n = 50), diphenhydramine (30 mg/1 ml; n = 50), and nalbuphine (10 mg/1 ml; n = 50), respectively, after delivery of the baby. The occurrence and the severity of pruritus were assessed at 1, 4, 12, and 24 hours after surgery.
RESULTS:
The overall incidence of pruritus during the 24 hr follow-up period was 72%, 68%, and 44% for group S, group D, and group N, respectively. Pruritus occurred less frequently in group N than group D (p = 0.027). At 4 and 12 hrs postoperatively, the pruritus severity was significantly different (p = 0.003 and p = 0.002) and was significantly less in group N than group D in the intergroup comparison (p = 0.013 and p = 0.012).
CONCLUSION:
Nalbuphine proved better than diphenhydramine for prevention of epidural morphine-induced pruritus in patients who underwent cesarean section. Prophylactic intramuscular nalbuphine (10 mg) is effective in decreasing the incidence and severity of pruritus and does not affect analgesia.
AuthorsChia-Chih Liao, Chieh-Szu Chang, Chi-Hao Tseng, Michael J Sheen, Shih-Chang Tsai, Yao-Lung Chang, Shu-Yam Wong
JournalChang Gung medical journal (Chang Gung Med J) 2011 Mar-Apr Vol. 34 Issue 2 Pg. 172-8 ISSN: 2309-835X [Electronic] China (Republic : 1949- )
PMID21539759 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
Chemical References
  • Analgesics, Opioid
  • Morphine
  • Diphenhydramine
  • Nalbuphine
Topics
  • Adult
  • Analgesia, Epidural (adverse effects)
  • Analgesia, Obstetrical (adverse effects)
  • Analgesics, Opioid (adverse effects)
  • Cesarean Section
  • Diphenhydramine (therapeutic use)
  • Double-Blind Method
  • Female
  • Humans
  • Injections, Intramuscular
  • Morphine (adverse effects)
  • Nalbuphine (therapeutic use)
  • Pregnancy
  • Prospective Studies
  • Pruritus (prevention & control)

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