title: Continous epidural butorphanol decreases the incidence of intrathecal morphine-related pruritus after cesarean section: a randomized, double-blinded, placebo-controlled trial: Epidural butorphanol decreases the incidence of intrathecal morphine-related pruritus.
abstract: This randomized, double-blinded, placebo-controlled trial investigated the effect of continuous epidural butorphanol on intrathecal morphine-related pruritus in patients undergoing cesarean section. Eighty-three patients undergoing elective cesarean section under spinal anesthesia (1.5 mL of isobaric bupivacaine 0.5 % and 0.1 mg of preservative-free morphine) were enrolled in this study. Subjects were randomized to receive epidural butorphanol (n = 43) or normal saline combined bupivacaine (n = 40). In the study group, after the umbilical cord was clamped, patients were administered an epidural loading dose of 1 mg followed by a 48-h infusion of 0.004 % butorphanol with 0.1 % bupivacaine at a rate of 2 mL/h. In the normal saline group, saline was used for the loading dose and the infusion 0.1 % bupivacaine at a same rate. Postoperatively, a blinded observer recorded the incidence/severity of pruritus, visual analog pain scores and sedation level at 1, 3, 6, 9, 12, 24 and 48 h. The 48-h consumption of breakthrough analgesic (tramadol) was also noted. The primary outcome was the incidence of pruritus at 48 h. At 48 h, the incidence of pruritus was significantly lower in the butorphanol group (16.3 vs. 52.5 %; P < 0.001). Furthermore, compared with the normal saline group, the intensity of pruritus was also decreased with epidural butorphanol at 3, 6 and 9 h (all P ≤ 0.008). The pain scores were significantly lower at 12, 24 and 48 h (all P < 0.05) in the butorphanol groups. Patients only receiving bupivacaine required a higher cumulative dose of tramadol (37.5 ± 62.8 vs. 9.3 ± 36.6; P = 0.014). In patients undergoing elective cesarean section, continuous epidural butorphanol with bupivacaine decreases the incidence and severity of intrathecal morphine-related pruritus without adversely affecting the quality of postoperative analgesia.
authors.affiliation: Department of Anesthesia, Jiangyin Hospital, Medical College of Southeast University, No. 163, Shoushan Rd, Jiangyin, 214400, People's Republic of China, drwuzhen2013@163.com.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wu
authors.forename: Mingjian
authors.initials: M
authors.lastname: Kong
authors.forename: Jianqing
authors.initials: J
authors.lastname: Chen
authors.forename: Laiyou
authors.initials: L
authors.lastname: Wen
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Jie
authors.initials: J
authors.lastname: Tan
mesh_terms: D000328:Adult; D002077:Butorphanol / Q000008:administration & dosage* / Q000494:pharmacology*; D002585:Cesarean Section; D004311:Double-Blind Method; D004824:Epidural Space; D005260:Female; D006801:Humans; D015994:Incidence; D007278:Injections, Spinal; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects*; D010919:Placebos; D011537:Pruritus / Q000139:chemically induced* / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D010919:Placebos; D009020:Morphine; D002077:Butorphanol