title: The impact of nalmefene on side effects due to intrathecal morphine at cesarean section.
abstract: Nalmefene is a long-acting opioid antagonist that provides long-term relief from side effects of intrathecal morphine sulfate. A randomized, double-blind, placebo-controlled study was conducted to determine whether prophylactic nalmefene could decrease side effects of intrathecal morphine given during cesarean section, without affecting analgesia. Sixty parturients were given 0.25 mg of intrathecal morphine, 12.5 micrograms of fentanyl, and 11.25 to 15 mg of bupivacaine. A dose of 0.25 microgram/kg of nalmefene or placebo was given by intravenous piggyback immediately after delivery of the neonate. Nausea, vomiting, pruritus, and level of sedation were assessed for a 24-hour period using a 4-point ordinal scoring system. Pain was assessed by using a 0- to 10-point verbal analogue scale. A 5-point analgesic satisfaction survey also was completed. Subjects who received nalmefene required supplemental analgesia at a median of 6.00 hours after intrathecal morphine, compared with 14.12 hours in the placebo group (P = .037). No differences were found between the groups in the incidence of pruritus, nausea and vomiting, level of sedation, or analgesic satisfaction. We concluded that nalmefene at a dose of 0.25 microgram/kg does not decrease the incidence of side effects but increases the need for supplemental analgesics.
authors.affiliation: Naval Medical Center, Portsmouth, Va., USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Pellegrini
authors.forename: S L
authors.initials: SL
authors.lastname: Bailey
authors.forename: J
authors.initials: J
authors.lastname: Graves
authors.forename: J A
authors.initials: JA
authors.lastname: Paice
authors.forename: S
authors.initials: S
authors.lastname: Shott
authors.forename: M
authors.initials: M
authors.lastname: Faut-Callahan
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D002585:Cesarean Section; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D009020:Morphine / Q000009:adverse effects*; D009271:Naltrexone / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000139:chemically induced / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000517:prevention & control; D011247:Pregnancy; D011537:Pruritus / Q000139:chemically induced / Q000517:prevention & control; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009271:Naltrexone; D009020:Morphine; C038981:nalmefene