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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study aimed to compare the efficacy and side-effects of sublingual buprenorphine, a synthetic opioid agonist antagonist, with those of subcutaneous morphine. Fifty ASA class 1 patients were included in the study after having given their informed consent. Caesarean section was carried out under epidural block with 0.5% bupivacaine; no opioids were used during the procedure. The first dose of opioid was given 2 h after the first dose of bupivacaine. Patients were randomly given either 10 mg morphine (n = 25) or 0.4 mg buprenorphine (n = 25), followed by the same dose every 6 h for 36 h. When analgesia was insufficient, tablets containing dextropropoxyphene and paracetamol were given. No attempt was made to blind the study to the patient, but the investigator assessing pain was unaware of the drug given to the patient. Pain intensity was assessed before, and 2 h after each dose of opioid with a 100 mm visual scale, as well as systolic, diastolic and mean arterial blood pressures, heart and breathing rates, and SpO2. Side-effects (pruritus, nausea, vomiting, drowsiness) were also noted. In 2 patients in each group, the protocol was stopped before the 36th h, but after the fourth dose, either because of side-effects, or at the patient's request. Results were similar in both groups of patients, whether for degree of pain relief, or physiological effects. There was no clinically detectable respiratory depression. Duration and intensity of episodes of arterial oxygen desaturation, and the incidence of nausea, were similar in the 2 groups; pruritus was more common in the morphine group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Postoperative analgesia after cesarean section: sublingual buprenorphine versus subcutaneous morphine]. 237 54

This study examined the efficacy of patient-controlled epidural analgesia (PCEA) during labor and compared the suitability of three different PCEA solutions. After establishing effective epidural analgesia with 12 ml of 0.25% bupivacaine, 72 parturients in active labor were randomly assigned to one of four groups: physician-controlled continuous epidural infusion using 0.125% bupivacaine (CEI); PCEA using 0.125% bupivacaine (B); PCEA using 0.125% bupivacaine with fentanyl 1 micrograms/ml (BF); and PCEA using 0.125% bupivacaine with fentanyl 1 micrograms/ml and 1:400,000 epinephrine (BFE). The CEI infusion was begun at 12-16 ml/h and adjusted to maintain a T10 sensory level and adequate pain relief. PCEA pumps were programmed to deliver a 6 ml/h basal infusion, 4 ml on-demand boluses, 10-min lockout intervals between doses, and a 20 ml hourly limit. Hemodynamic parameters, sensory level, quality of analgesia, duration of labor, overall satisfaction, and Apgar scores did not differ among groups. Compared with CEI, PCEA with plain bupivacaine did not decrease total local anesthetic usage or average hourly infusion rates during labor. However, addition of fentanyl (groups BF and BFE) decreased hourly infusion requirements. Average hourly infusion rates were 13.0 +/- 1.1 ml/h (B), 10.6 +/- 0.6 ml/h (BF), and 9.6 +/- 0.5 ml/h (BFE); group B differs from others (P less than 0.05). No instance of respiratory depression or complication secondary to PCEA was observed. Mild pruritus occurred only with fentanyl-containing solutions, whereas dense motor block developed more frequently with the epinephrine-containing solution.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Patient-controlled epidural analgesia during labor: a comparison of three solutions with a continuous infusion control. 222 55

The efficacy of epidural hydromorphone alone or in combination with epinephrine for postoperative analgesia was evaluated in 30 healthy women who underwent cesarean delivery with epidural anesthesia. They were assigned randomly to receive either 1.5 mg hydromorphone alone (N = 15) or 1.5 mg hydromorphone with 1/200,000 epinephrine (N = 15). Duration of analgesia (mean +/- SD) was 24.3 +/- 9.4 hours after the epidural injection of hydromorphone plus epinephrine. This was significantly greater (p less than 0.01) than the duration of 18.2 +/- 5.9 hours after the same dose of plain hydromorphone. Analgesia was more rapid in onset and significantly better at the 0.5, 1, 3, and 12 hours postoperatively in the hydromorphone-epinephrine group. Side effects including pruritus (73%), nausea (20%), and vomiting (15%) were of similar frequency with and without epinephrine. Although mean venous PCO2 (PvCO2) levels three and six hours after the hydromorphone-epinephrine dose were elevated significantly over the pre-drug PvCO2 levels, no respiratory depression was detected by an apnea monitor to which all patients were connected. The addition of epinephrine to epidural hydromorphone hastened onset and prolonged the duration of analgesia after cesarean section.
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PMID:Epidural hydromorphone with and without epinephrine for post-operative analgesia after cesarean delivery. 246 9

Forty-three patients with disseminated refractory malignancies each received an individually-specified combination of either Adriamycin (24 patients) or mitomycin-C (19 patients) conjugated murine monoclonal antibodies. Tumors were typed using a panel of antibodies with both immunohistochemistry and flow cytometry. Cocktails of up to six antibodies were selected based on binding greater than 80% of the malignant cells in the biopsy specimen. These monoclonal antibody cocktails were drug conjugated and administered intravenously. Seventeen out of twenty-four patients had reactions to the administration of Adriamycin immunoconjugates, but these were tolerable in all but two patients. Fever, chills, pruritus and skin rash were by far the most common transitory reactions. All were well controlled with premedication. In several patients it was demonstrated that there was limited antigenic drift among various biopsies within the same patient over time. Up to 1 gram of Adriamycin and up to 5 grams of monoclonal antibody were administered. The limiting factor appeared to be a variable dissociation of active Adriamycin from the antibody which unpredictably caused hemopoietic depression. Similar findings were noted in 19 patients with mitomycin-C conjugates. Thrombocytopenia at a 60mg dose of mitomycin-C in this schedule was dose limiting. Preliminary serological evidence suggests that the development of an IgM antibody which is specific against the mouse monoclonal antibody has the specificity and sensitivity to predict clinical reactions. These antibodies were quantitatively less in mitomycin-C patients. Selected patients were re-treated. One patient with chronic lymphocytic leukemia had re-treatment on three occasions and demonstrated regression of peripheral lymph nodes. Two patients with breast carcinoma had definite improvement in ulcerating skin lesions and two patients with tongue carcinoma had shrinkage of their lesions. No responses were seen with mitomycin-C conjugates but binding was noted to tumors and colon with likely drug induced colitis seen after colon binding. This study demonstrates the feasibility and illustrates technical considerations in preparing drug immunoconjugate cocktails for patients with refractory malignancies. Cocktail formulation and antibody delivery was accomplished. The major technical hurdle appears to be the selection of effective conjugation methods that can be used to optimally bind drugs to monoclonal antibodies for targeted cancer therapy.
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PMID:Individually specified drug immunoconjugates in cancer treatment. 250 30

The discovery of opiate receptors and naturally occurring opiate-like substances in the central nervous system started a new era in pain control. Epidural and spinal opiates have been increasingly used since 1979. However, applying these analgesic techniques in obstetrics has been criticized because of possible side-effects on the mother and foetus. In this literature survey, their advantages and disadvantages are analyzed. Maternal side-effects include pruritus, nausea, urinary retention, and, most of all, respiratory depression. As a general rule, these side-effects are greater with the intrathecal route, high doses, and the use of morphine. The effects on the course of labour are small, and neonatal status is not altered. Spinal and epidural opiates are efficient analgesic techniques for labour and caesarean section. They provide a dose-related, but not surgical, analgesia. Currently, there is a great deal of interest in mixtures of a diluted local anaesthetic agent and a lipophilic drug for use during labour or caesarean section. An opiate alone may not consistently provide satisfactory analgesia during labour, and it cannot be recommended for routine use, except for patients in whom the cardiovascular effects of routine regional anaesthesia are to be avoided. The choice of a lipid-soluble opiate like fentanyl is safe. However, when considering new drugs, great care must be taken to avoid unforeseen problems. A good knowledge of the problem and a cautious approach combined with careful monitoring of the respiratory rate and adequacy of ventilation are the keys to the safe use of spinal and epidural opiates.
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PMID:[Use of epidural and intrathecal opiates in obstetrics]. 257 18

Patients undergoing thoracotomy experience severe post-operative pain and marked respiratory impairment, which causes pulmonary atelectasis and pneumonia. The effects of epidural injection on postoperative pain and respiratory function were examined in this study. The group undergoing epidural injection of 3 mg morphine (at the end of operation, 09oo and 21oo for the next 3 days) included 37 patients, while the control group involved 16. The number of required analgesics on the operating day and next three days were compared between the two groups. And postoperative vital capacity (VC), forced expiratory volume in the first second (FEV1), maximum mean flow (MMF) were compared with preoperative value. Patients receiving epidural morphine required significantly less analgesics throughout the postoperative periods (p less than 0.01). The morphine injected group had significantly better value in VC and FEV1 in the first two postoperative day (p less than 0.01), while significance were seen only in the first postoperative day in MMF (p less than 0.01). It seems that epidural morphine is highly effective in alleviating pain and improving respiratory function in post-thoracotomy patients. These effects help the expectoration of sputum especially in senile patients. As the side-effects of epidural morphine, urinary retention, nausea, vomiting and itching were seen in few patients. No serious side effect such as hypotension or ventilatory depression were seen.
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PMID:[The effect of epidural injection with morphine on the post-thoracotomy respiratory function]. 261 15

Epidural analgesia is an important intervention in patients with pain after surgery. This article presents a brief overview of the anatomy of the epidural space and the physiology of pain transmission, including the action of narcotics in pain relief. The importance of written nursing protocols and in-service education for nursing staff members is discussed as being a necessary prerequisite for the safe use of epidural analgesia. A flow diagram with rationale illustrates the epidural injection technique. Nursing care of patients receiving epidural narcotics is detailed. The discussion emphasizes the management of potential side effects from epidural narcotics (respiratory depression, urinary retention, pruritus, pain on injection, dizziness, nausea, and vomiting) and includes information on the use of a narcotic antagonist. Recommendations are made for preoperative and postoperative teaching of the patient and family. A variety of tools for assessing patients' pain levels are described, and a comprehensive nursing care plan with nursing diagnoses and nursing interventions is provided.
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PMID:Nursing management of patients receiving epidural narcotics. 264 76

A double-blind study of patients selected at random compared the analgesic and adverse effects of intrathecal methadone (1 mg) with those of intrathecal morphine (0.5 and 1 mg). The study was conducted on 30 patients who underwent major orthopedic or urologic surgery. The intrathecal opioid was administered at the end of surgery, and assessments began 1 h thereafter and continued for 20 h. Pain measurements, supplementary analgesia requirements, and adverse effects were recorded. Intrathecal morphine (0.5 and 1 mg) provided effective and prolonged analgesia. Methadone, however, was unable to ensure the same degree of analgesia; consequently, the median pain scores were consistently higher following methadone than morphine (0.5 and 1 mg) (P less than 0.05). The time to the onset of discomfort severe enough to require supplemental morphine was longer after intrathecal morphine than that following methadone (24 and 29 h with morphine 0.5 and 1 mg; 6.5 h with methadone; P less than 0.05). Respiratory depression (increases PaCO2) was not associated with methadone and morphine 0.5 mg but was common following morphine 1 mg (P less than 0.05). Facial pruritus was unique to intrathecal morphine. Urinary retention requiring bladder catheterization was more frequent following morphine than methadone, although this was not statistically significant. Nausea and vomiting were common to all groups. Intrathecal morphine (0.5 and 1 mg) provides superior postoperative analgesia to 1 mg methadone. Various explanations for the observed differences between the drugs are discussed, including the possibility that the dose of methadone used in the subarachnoid space was inadequate and that a larger dose might have produced an effect equal to that of morphine.
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PMID:Intrathecal methadone and morphine for postoperative analgesia: a comparison of the efficacy, duration, and side effects. 235 28

A randomised double-blind study compared the dose-response relationship of intrathecal diamorphine (0, 0.25, 0.75, 1.5, and 2.5 mg) for postoperative pain relief, in 35 subjects who underwent total knee replacement surgery. Assessments commenced 2 h after the opioid injection and continued for 20 h. Pain, analgesic effect, supplementary analgesic requirements and adverse effects were noted. Intrathecal diamorphine was unable to delay the initial perception of discomfort. It was, however, capable of postponing the onset of severe pain requiring analgesic supplementation (control 5.25 h vs approximately 8 h: P less than 0.05). There was no significant difference in the quality of analgesia between the groups. Pruritus was the only undesirable feature unique to intrathecal diamorphine administration. Intrathecal diamorphine was safe and was not associated with clinically apparent respiratory depression. Its effects were inconsistent and its use was associated with irritating side effects. Possible explanations for the erratic behaviour of the diamorphine are discussed.
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PMID:Intrathecal diamorphine: a dose-response study. 233 97

The literature was reviewed for cases of cutaneous pigmentation induced by rifampicin overdosage. 29 examples have been described, in which 2 general groups of individuals were observed. The first consisted of older individuals (average age 27.1 years) who attempted suicide. A prior history of suicide attempts, depression and substance abuse was a predominant factor in these patients. The second group included generally younger patients (average age 2.9 years) in whom misformulation of rifampicin preparations for treatment of Haemophilus influenzae Type B resulted in bright reddish-orange discoloration to the skin. The time to clinical appearance of skin discoloration was approximately 2.2 hours after administration. Periorbital or facial oedema occurred in 72.4% of the patients, pruritus in 62.1% and either nausea, vomiting or diffuse abdominal tenderness in 51.7%. Limited laboratory data are available but these indicate that all patients had elevated levels of total bilirubin. Histological examination in selected individuals revealed rifampicin crystal deposits in the nasopharynx, gastrointestinal tract and lining of the aorta. In adults, it appears that a dose of at least 14 g of rifampicin is necessary before cardiovascular-pulmonary arrest occurs. Other than general supportive measures, very few methods are described in the literature for the treatment of acute intoxications with this drug. A differential diagnosis of other causes of reddish-orange pigmentation is discussed, together with clinical information to differentiate these cases from toxic rifampicin ingestion.
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PMID:A review of the Redman syndrome and rifampicin overdosage. 268 37


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