Browse > Article

Effects of Epidural Naloxone on Pruritus Induced by Hydromorphone Epidural Patient-Controlled Analgesia  

Bang, Si Ra (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Kim, Hee Suk (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Kim, Ji Hyeok (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Sim, Woo Seok (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Gwak, Mi Sook (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Yang, Mi Kyung (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Kim, Chung Su (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Hahm, Tae Soo (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Cho, Hyun Sung (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Choi, Duck Hwan (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Kim, Tae Hyeong (Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Publication Information
The Korean Journal of Pain / v.19, no.1, 2006 , pp. 91-95 More about this Journal
Abstract
Background: Opioid delivered by epidural patient-controlled analgesia (PCA) is effective in relieving pain after surgery, but it is associated with side effects, such as nausea, vomiting, pruritus, respiratory depression, and urinary retention. The purpose of this study was to compare hydromorphone related side effects and the quality of analgesia when naloxone was added to epidural PCA regimen. Methods: Fifty-two thoracotomy patients with PCA were allocated blindly into two groups. Patients in group H (n = 26) received continuous epidural hydromorphone ($16{\mu}g/ml$) in 0.1% bupivacaine; patients in group N (n = 26) received an epidural infusion containing naloxone ($2{\mu}g/ml$) and hydromorphone ($16{\mu}g/ml$) in 0.1% bupivacaine. The basal rate of PCA was 4 ml/hr and the demand dose was 1.5 ml with a lockout time of 15 min. Pain intensity, sedation, pruritus, nausea and vomiting, respiratory depression were checked at 6, 12, 24 hours postoperatively. Results: The Visual Analog Scale (VAS) scores were significantly lower in group H than in group N. There were no significant differences in the overall incidence of pruritus, nausea and sedation between the two groups. Conclusions: Continuous epidural infusion of naloxone combined with hydromorpho-ne is not effective in reducing the incidence and severity of pruritus induced by epidural hydromorphone.
Keywords
bupivacaine; epidural; hydromorphone; naloxone; PCA;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Shulman MS, Waketlin G, Yamaguchi L, Brodsky JB: Experience with epidutal hydtomotphone for post-thoracotomy pain relief. Anesth Analg 1987; 66: 1331-3
2 Levine JD, Gotdon NC: Method of administration detetmines the effect of naloxone on pain. Brain Res 1986; 365: 377-8   DOI   ScienceOn
3 Gan TJ, Ginsbetg B, Glass PS, Fottney J, Jhaveti R, Perno R: Opioid-sparing effects of a low-dose infusion of naloxone in patient-dministeted motphine sulfate. Anesthesiology 1997; 87: 1075-81   DOI   ScienceOn
4 Sattain JB, Barry JJ, Richardson CA, Branagan HC: Effect of combining naloxone and motphine for intravenous patient-ontrolled analgesia. Anesthesiology 2003; 99: 148-51   DOI   ScienceOn
5 Ballantyne JC, Carr DB, Chalmers TC, Dear KB, Angelillo IF, Mosteller F: Postoperative patient-controlled analgesia: meta analyses of initial randomized control trials. J Clin Anesth 1993; 5: 182-93   DOI   ScienceOn
6 Choi JH, Lee JM, Kim ES, Kang SH: The optimal dose range of epidural naloxone to minimize nausea during continuous epidutal infusion of motphine. Kotean J Anesthesiol 2005; 48: 538-1
7 Halpern SH, Arellano R, Preston R, Carstoniu J, O'Leary G, Roger S, et al: Epidutal motphine vs hydtomotphone in post-caesarean section patients. Can J Anesth 1996; 43: 595-8   DOI
8 Levine JD, Gordon NC, Fields HL: Naloxone dose dependently produces analgesia and hyperalgesia in postoperative pain. Natute 1979; 278: 740-1   DOI   ScienceOn
9 Toshiyuki O, Miwako S, Junko M, Kan A: Prophylactic epidutal naloxone teduces the incidence and severity of neuraxial fentanyl-induced pruritus during labout analgesia in pfimipatous parturients. Can J Anesth 2003; 50: 961-2   DOI
10 Dahl JB, Rosenberg J, Hansen BL, Hjortso NC, Kehlet H: Differential analgesic effects of low-dose epidutal morphine and morphine-upivacaine at rest and during mobilization aftet majot abdominal sutgery. Anesth Analg 1992; 74: 362-5
11 Cepeda MS, Afticano JM, Manrique AM, Ftagoso W, Carr DB: The combination of low dose of naloxone and motphine in PCA does not decrease opioid tequitements in the postoperative period. Pain 2002; 96: 73-9   DOI   ScienceOn
12 Yoon HD: Effects of Low-dose Naloxone on Postoperative Analgesia and Side Effects in Inttavenous Patient-Controlled Analgesia after a Total Hysterectomy. Kotean J Anesthesiol 2001; 41: 720-6   DOI
13 Walder B, Schafer M, Henzi I, Tramer MR: Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain. A quantitative systemic review. Acta Anaesthesiol Scand 2001; 45: 795-804   DOI   ScienceOn
14 Mahon SV, Betty PD, Jackson M, Russell GN, Pennefathet SH: Thoracic epidural infusions fot post-thotacotomy pain: a comparison of fentanyl-bupivacaine mixtutes vs. fentanyl alone. Anaesthesia 1999; 54: 641-6   DOI   ScienceOn
15 Chaplan SR, Duncan SR, Brodsky JB, Brose WG: Morphine and hydromorphone epidural analgesia. A prospective, tandomized comparison. Anesthesiology 1992; 77: 1090-4   DOI   ScienceOn
16 Coda B, Tanaka A, Jacobson RC, Donaldson G, Chapman CR: Hydfomorphone analgesia aftet inttavenous bolus administration. Pain 1997; 71: 41-8   DOI   ScienceOn
17 Goodatzi M: Compatison of epidural morphine, hydromorphone and fentanyl for postoperative pain conttol in childten undetgoing orthopaedic surgery. Paediatt Anaesth 1999; 9: 419-22   DOI   ScienceOn
18 Rapp SE, Egan KJ, Ross BK, Wild LM, Terman GW, Ching JM: A multidimensional compatison of motphine and hydromorphone patient-controlled analgesia. Anesth Analg 1996; 82: 1043-8   DOI
19 Gowan JD, Huttig JB, Fraser RA, Torbicki E, Kitts J: Naloxone infusion after prophylactic epidural morphine: effects on incidence of postoperative side effects and quality of analgesia. Can J Anesth 1988; 35: 143-8   DOI
20 Dunbat PJ, Chapman CR, Buckley FP, Gavrin JR: Clinical analgesic equivalence for morphine and hydromorphone with prolonged PCA. Pain 1996; 68: 265-70   DOI   ScienceOn
21 Sarhill N, Walsh D, Nelson KA: Hydromotphone: pharmacology and clinical applications in cancel patients. Support Care Cancel 2001; 9: 84-96   DOI   ScienceOn
22 Jeon Y, Hwang J, Kang J, Han S, Rhee K, Oh Y: Effects of epidutal naloxone on pturitus induced by epidural motphine: a tandomized controlled trial. Int J Obstet Anesth 2005; 14: 22-5   DOI   ScienceOn
23 Fischer RL, Lubenow TR, Liceaga A, McCarthy RJ, Ivankovich AD: Comparison of continuous epidural infusion of fentanyl-upi-vacaine and morphine-bupivacaine in management of postoperative pain. Anesth Analg 1988; 67: 559-63
24 Hjortso NC, Lund C, Mogensen T, Bigler D, Kehlet H: Epidutal morphine improves pain relief and maintains sensory analgesia during continuous epidutal bupivacaine aftet abdominal surgety. Anesth Analg 1986; 65: 1033-6