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

Abstract

BACKGROUND:

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.

• Authors: Chia-Chih Liao, Chieh-Szu Chang, Chi-Hao Tseng, Michael J Sheen, Shih-Chang Tsai, Yao-Lung Chang, Shu-Yam Wong
• Journal: Chang Gung medical journal (Chang Gung Med J) 2011 Mar-Apr Vol. 34 Issue 2 Pg. 172-8 ISSN: 2309-835X [Electronic] China (Republic : 1949- )
• PMID: 21539759 (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)