title: Dose-dependent attenuation of intravenous nalbuphine on epidural morphine-induced pruritus and analgesia after cesarean delivery.
abstract: Epidural morphine in patient-controlled analgesia regimens controls postoperative pain well but easily induces pruritus and other epidural morphine-related side effects. With 90 pregnant American Society of Anesthesiologists physical status II females scheduled for elective cesarean delivery, the present study was designed to evaluate the efficacy and safety profile of patient-controlled antipruritus (PCP) use of intravenous nalbuphine-based regimens for attenuation of postoperative pruritus and related side effects in combination with epidural morphine patient-controlled analgesia with regard to the quality of postoperative pain management. Patients were randomly assigned to two nalbuphine groups (5 μg/kg/hour, Group N5 or 10 μg/kg/hour, Group N10) and bolus dose of 1.6 μg/kg for PCP or the control (normal saline) group. Comparable visual analog scale scores for rest pain at each measured time interval among the three groups demonstrated that adequate pain relief was offered; however, the cumulative dose of nalbuphine administered to the patients in Group N10 attenuated the analgesic effect of epidural morphine in moving pain at POh24 only. Fewer episodes and milder severity of pruritus were observed in patients in Groups N5 and N10 at all postoperative time intervals. Epidural morphine provided good postoperative pain relief but with incommodious side effects. In addition, intravenous nalbuphine not only attenuated the incidence of pruritus but also decreased total morphine consumption. In conclusion, intravenous administration of low-dose nalbuphine (5 μg/kg/hour) for PCP maintained analgesia produced by epidural morphine and offered low pruritus incidence.
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.
authors.forename: Mao-Kai
authors.initials: MK
authors.lastname: Chen
authors.affiliation: Department of Anesthesiology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung City, Taiwan.
authors.forename: Siu-Wah
authors.initials: SW
authors.lastname: Chau
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.
authors.forename: Ya-Chun
authors.initials: YC
authors.lastname: Shen
authors.affiliation: Department of Anesthesiology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung City, Taiwan.
authors.forename: Yu-Ning
authors.initials: YN
authors.lastname: Sun
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.
authors.forename: Kuang-Yi
authors.initials: KY
authors.lastname: Tseng
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung City, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Chen-Yu
authors.initials: CY
authors.lastname: Long
authors.affiliation: Graduate Institute of Healthcare Administration, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors.forename: Yu-Tung
authors.initials: YT
authors.lastname: Feng
authors.affiliation: Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan. Electronic address: chengkuangi@gmail.com.
authors.forename: Kuang-I
authors.initials: KI
authors.lastname: Cheng
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D002585:Cesarean Section / Q000009:adverse effects; D003710:Demography; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D009266:Nalbuphine / Q000008:administration & dosage / Q000494:pharmacology*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D011247:Pregnancy; D011537:Pruritus / Q000139:chemically induced*; D055815:Young Adult
chemical_list: D009020:Morphine; D009266:Nalbuphine
keywords: Cesarean delivery; Epidural morphine; Nalbuphine; Patient-controlled antipruritus
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