title: [Treatment of epidural morphine induced pruritus with butorphanol].
abstract: BACKGROUND
  Epidural morphine has been used to provide postoperative analgesia. However, one of the most common side effects of epidural morphine is pruritus. The incidence may or may not be related to the dose of morphine administered. First, we examined whether epidural morphine induced a dose-related increase in pruritus or not. Secondly, the purpose of this study was to evaluate the relief of pruritus when a combination of epidural morphine (a mu-receptor agonist) and butorphanol (a mu-receptor antagonist and kappa-receptor agonist) was administered.
  
  
  METHODS
  The incidence of pruritus, in 100 patients after abdominal surgery receiving continuous epidural analgesia with 0.2% ropivacaine + morphine, was retrospectively evaluated. Secondly, 60 adult patients undergoing abdominal surgery were randomly assigned to receive one of three epidural regimens; (1) continuous infusion of 0.2% ropivacaine with morphine 3.3 mg x day(-1) + butorphanol 2 mg x day(-1) (group MB), (2) morphine 3.3 mg x day(-1) alone (group M), or (3) butorphanol 2 mg x day(-1) alone (group B) at a rate of 4 ml x hr(-1), for 75 hours.
  
  
  RESULTS
  Continuous epidural morphine at more than 3 mg x day(-1) caused a dose-related increase in pruritus. Pruritus was 0% in group B and group MB, but 55% in group M.
  
  
  CONCLUSIONS
  Butorphanol 2 mg x day(-1) was effective in preventing pruritus associated with continuous epidural infusion of morphine 3.3 mg x day(-1).
authors.affiliation: Department of Anesthesiology, Ako City Hospital, Ako 678-0232.
authors.forename: Yae
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Tadashi
authors.initials: T
authors.lastname: Yokoyama
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Nagao
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Magaribuchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000009:adverse effects*; D002077:Butorphanol / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009022:Morphine Derivatives / Q000008:administration & dosage* / Q000009:adverse effects*; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use; D011537:Pruritus / Q000139:chemically induced* / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: D009022:Morphine Derivatives; D009292:Narcotic Antagonists; D002077:Butorphanol