The effect of celecoxib on intrathecal morphine-induced pruritus in patients undergoing Caesarean section.
Pruritus associated with intrathecal opioid administration is particularly common in pregnancy. Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce the severity of this pruritus but have undesirable side effects. The recent development of drugs that can specifically inhibit the cyclooxygenase 2 isoenzyme have become an attractive alternative. This study was designed to evaluate the efficacy of such a drug (celecoxib) in reducing intrathecal opioid-induced pruritus in a randomised double-blinded study of 60 women undergoing Caesarean section. All of them received spinal anaesthesia with 3 ml of 0.5% hyperbaric bupivacaine and 0.3 mg preservative-free morphine. After delivery of the baby, they received either oral celecoxib 200 mg or placebo. Visual analogue scores for pain and pruritus were measured at 30 min, 2, 4, 8, and 24 h. There was no difference in the severity and onset of pain and pruritus between the two groups. Timing of administration, inadequate dosing and possible altered pharmacokinetics in pregnancy may explain the lack of efficacy.
Lee
L H Y
LH
Department of Anaesthesiology, Universiy of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong. libbylee@hkucc.hku.hk
Irwin
M G
MG
Lim
J
J
Wong
C K
CK
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects; D000775:Anesthesia, Spinal / Q000009:adverse effects; D000982:Antipruritics / Q000627:therapeutic use*; D000068579:Celecoxib; D002585:Cesarean Section; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D009020:Morphine / Q000009:adverse effects; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D011247:Pregnancy; D011537:Pruritus / Q000139:chemically induced / Q000517:prevention & control*; D011720:Pyrazoles; D013449:Sulfonamides / Q000627:therapeutic use*
D000701:Analgesics, Opioid; D000982:Antipruritics; D016861:Cyclooxygenase Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D009020:Morphine; D000068579:Celecoxib