Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

At the beginning, the way intrathecal morphine was used for postoperative pain relief was quite unfortunate, because the doses derived from experience with morphine-tolerant cancer patients were considerably too high and respiratory depression occurred frequently. Subsequent dose-finding studies showed that the doses of morphine used initially could be reduced by a factor of ten without loss of the analgesic effect and with a marked reduction in side-effects. No respiratory depression has been reported when doses below 0.1 mg morphine are used. METHOD. In this prospective study the effect of 0.06 to 0.08 mg intrathecal morphine, mixed with the local anaesthetic for spinal anesthesia, was investigated in surgical patients aged 21 to 81 years, ASA grade I or II, scheduled for orthopaedic operations or herniorraphies. Thirty unpremedicated patients were enrolled in the study and were, after informed consent, randomly allocated to a control group without morphine or to a morphine group. The analgesic effect was assessed by the time interval between the administration of the spinal anaesthesia and the first demand for an analgesic medication. The mood state was evaluated with the adjective checklist of Janke and Debus 6 h after the spinal anaesthesia. RESULTS AND DISCUSSION. In the control group half of the patients asked for an analgesic medication within 275 min (median) after the spinal anaesthesia, and all patients within 420 min, whereas in the morphine group half of the patients asked for an analgesic within 1170 min (median). Seven patients had not required an analgesic at the termination of the observation period 20 h after the spinal anaesthesia. The mood status showed no difference between the two groups, in particular, no dizziness or drowsiness after morphine. There was no difference in the incidence of side-effects such as nausea or urinary retention between the two groups. Pruritus was not reported spontaneously but was found upon questioning in five patients. It was in no case disturbing. CONCLUSIONS. Morphine (0.06 to 0.08 mg) mixed with the local anaesthetic for spinal anaesthesia provided for an analgesia of more than 20 h duration in half of the patients. This technique is safe, simple, reliable and virtually free of side-effects. No particular supervision due to the administration of intrathecal morphine is necessary in this dose range if systemic opiates are avoided. If the analgesia is unsatisfactory, a non-opioid analgesic is recommended.
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PMID:[Intrathecal morphine for postoperative pain]. 146 57

We investigated the efficacy of subhypnotic doses of propofol for spinal morphine-induced pruritus in a prospective, randomized, double-blind, placebo-controlled study. Fifty patients, ASA physical status 1-3, with spinal morphine-induced pruritus were allocated to receive either 1 ml propofol (10 mg) or 1 ml placebo (Intralipid) intravenously after gynecologic, orthopedic, thoracic, or gastrointestinal surgery. In the absence of a positive response, a second drug treatment was given 5 min later. The persistence of pruritus 5 min after the second treatment dose was considered a treatment failure. All failures then received, in an open fashion, a supplementary dose of propofol (10 mg) and were reevaluated 5 min later. Both groups were well matched. The success rate was significantly greater in the propofol group (84%) than in the placebo (16%) group (P less than 0.05). Ninety percent of the treatment failures in the placebo group were successfully treated by a supplementary dose of 10 mg propofol. Eight percent of the patients (4% in each group) were resistant to all treatments, including naloxone 0.08 mg intravenously. Three patients had a slight increase in sedation in the propofol group versus none in control (not significant). The beneficial effect of treatment was longer than 60 min in 85% of patients in the propofol group and in 100% of the controls (not significant). These results suggest that propofol in a subhypnotic dose is an efficient drug treatment for spinal morphine-induced pruritus. At the dose administered (10 mg), side effects were rare and minor.
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PMID:Subhypnotic doses of propofol relieve pruritus induced by epidural and intrathecal morphine. 155 Feb 75

Twenty-two patients of ASA physical status 1 or 2 undergoing surgery of the perineal region received intrathecal pethidine as the sole agent. The anesthetic effect of 0.5 mg.kg-1 (group 1) or 0.7 mg.kg-1 (group 2) of pethidine was evaluated and compared. Patients were randomly assigned to one of the two groups (12 in group 1 and 10 in group 2). Subarachnoid puncture was performed with the patient in the sitting position, using a 25 gauge spinal needle at the lumbar vertebral level of L4/5 or L5/S. The patients remained sitting for 5 min before being placed in the supine position. Two patients in the group 1 had inadequate sensory blockade and they were excluded from further study. The average segmental level of analgesia was S1 in group 1 and L2 in group 2. Motor blockade of the anal sphincter was seen in all patients. During the operation, the patients were stable hemodynamically and no respiratory depression was noticed. Prolonged postoperative analgesia was obtained and some patients did not require additional analgesics during postoperative period. Four patients complained of itching, two patients of nausea and two developed arrhythmias.
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PMID:[Spinal anesthesia with pethidine as the sole agent]. 207 94

The use of spinal opioids for postoperative analgesia has gained popularity in recent years. In this study, subarachnoid fentanyl 20 micrograms was evaluated to determine its efficacy for postoperative analgesia, its possible side effects and its effects on the newborn. Sixty ASA class I or II at-term parturients undergoing elective cesarean section were randomly divided into two groups. In one group fentanyl 20 micrograms (0.4 ml) with 0.5% heavy marcaine 2.0 ml was given intrathecally and in the other group only 0.5% heavy marcaine 2.0 ml with CSF 0.4 ml was given intrathecally. The average time for patients in the fentanyl group to demand the first dose of narcotic for pain was 6.8 +/- 3.2 h and in the control group it was 3.9 +/- 1.1 h. The incidences of postoperative nausea and vomiting were higher in the fentanyl group than in the control group. Pruritus was only found in the fentanyl group and amounted to 50%. Early or late respiratory depression was not found in the fentanyl group. During operation, all patients were wakeful and alert. Neonatal condition as determined by 1-min and 5-min Apgar score was satisfactory and showed no significant difference in both groups. Examination on neurobehavior and reflexes done at the baby room showed no abnormality in both groups.
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PMID:The evaluation of subarachnoid administration of fentanyl for surgery and postoperative analgesia in patients undergoing cesarean section. 209 85

We sought to compare epidural lidocaine to several short-acting epidural narcotics for their efficacy in controlling pain during extracorporeal shock wave lithotripsy (ESWL), hemodynamic changes, side effects and patient acceptance. To determine what contribution, if any, the local anesthetic test dose makes to the above factors, we also compared epidural sufentanil with and without a preceding test dose of local anesthetic with epinephrine. One hundred ASA I-III patients scheduled for elective ESWL were divided equally into five groups to receive one of the following epidural drugs through an epidural catheter: 2% lidocaine with 1:200,000 epinephrine (Group L), 1000 micrograms alfentanil (Group A), 200 micrograms fentanyl (Group F) or 60 micrograms sufentanil (Groups S and S-). Group S- differed from all other groups in omission of the test dose and direct injection of the opioid through the epidural needle. Significant hypotension occurred in 20% of patients in Group L compared to 0% in the narcotic groups (p less than 0.01). Clinically significant respiratory depression was not observed in any group. Mild pruritus was observed in up to 60% of patients in the narcotic groups (p less than 0.01). Sedation was observed in all of the narcotic groups, particularly in Group S-, in which more than half of patients were drowsy (p less than 0.05). Requirements for adjuvant analgesics during ESWL were highest in Group A. Patient acceptance was high throughout the study. We conclude that epidural alfentanil, fentanyl and sufentanil are as effective as epidural lidocaine plus epinephrine in providing analgesia during ESWL.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A comparison of epidural narcotics, with and without a test dose, to epidural lidocaine for extracorporeal shock wave lithotripsy. 214 29

The authors conducted a randomized double-blind controlled study comparing groups of patients receiving iv or epidural fentanyl infusions to determine whether, at comparable levels of analgesia, 1) the severity of side effects was different; and 2) plasma fentanyl concentrations differed between the two groups. Twenty-eight ASA physical status 2 women scheduled to undergo elective cesarean section were randomized into two groups to either receive fentanyl intravenously and saline epidurally or fentanyl epidurally and saline intravenously. After delivery of the infants under epidural anesthesia, each patient received a bolus of fentanyl 1.5 microgram/kg either intravenously or epidurally, and a fentanyl infusion was begun via the same route. Concurrently, a saline bolus and infusion were given via the alternate route. The rates of the fentanyl and saline infusions were adjusted until each patient was comfortable. Patients rated their pain, nausea, and pruritus on visual analogue scales. Sedation was evaluated by an observer. Respiratory depression was evaluated by end-tidal PCO2. Data were analyzed by unpaired two-tail t tests. Plasma fentanyl concentrations were measured at 12 and 24 h. Three patients in the iv group were dropped from the study because of inadequate pain relief. For the remaining 25 patients, similar infusion rates of fentanyl were required to produce similar levels of analgesia at 12 and 24 h. The severity of nausea, pruritus and sedation, and end-tidal PCO2 were similar for both groups. The plasma concentrations of fentanyl were significantly greater in those who received iv fentanyl at 12 h but not at 24 h.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after cesarean section. 200 64

The purpose of this study was to determine if a small dose of intrathecal meperidine would achieve adequate spinal anaesthesia while minimizing complications and to compare its effectiveness with lidocaine. The spinal anaesthetic effects of five per cent lidocaine 0.5 mg.kg-1 in 7.5 percent glucose (n = 20) or five per cent meperidine 0.5 mg.kg-1 (n = 22) were evaluated in 42 ASA physical status II or III patients. Intrathecal injection of the anaesthetic agent was given with the patient in the sitting position in which he remained for ten minutes before being placed in the lithotomy position. The onset time for sensory blockade was seven minutes in the lidocaine group and ten minutes in the meperidine group. Final sensory levels were identical in both groups. Mean arterial blood pressure decreased significantly in the lidocaine group but not in the meperidine group. Motor block was absent in ten patients in the meperidine group but was present in all the patients in the lidocaine group. Duration of postoperative analgesia was 968 min in the meperidine group and 681 min in the lidocaine group (NS). Complications such as nausea, vomiting, itching, drowsiness and respiratory depression were similar in the two groups. It is concluded that low-dose meperidine, 0.5 mg.kg-1, is effective as a spinal anaesthetic agent and has few complications.
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PMID:Comparison of intrathecal meperidine and lidocaine in endoscopic urological procedures. 219 5

Epidural narcotics has been shown to produce profound and long-lasting analgesia. It has been suggested that lipid-soluble narcotics such as fentanyl, because of their short transit time in the CSF, are less likely to be associated with delayed respiratory depression and side effects. We tried to combine low concentrations of fentanyl with bupivacaine to minimize side effects and to see if synergistic effect existed. Forty ASA physical status I or II patients who present for cholecystectomy were included in the trial. Before surgery a thoracic epidural catheter was inserted and pain control began when patients became fully awake and complained of pain in the recovery room after surgery. Patients were randomized in a double-blind fashion to one of four groups. Patients in group I were given epidural infusions of fentanyl 0.001%; patients in group 2 received fentanyl 0.001% mixed with bupivacaine 0.1%; patients in group 3 received fentanyl 0.0005%; patients in group 4 received fentanyl 0.0005% mixed with bupivacaine 0.1%. A continuous epidural infusion of these drugs began at a rate of 10 mL/h after a 5-mL bolus of the solution. Pain relief was assessed with visual analogue pain scale. Respiratory rates, vital signs, and mental status were assessed hourly. Except the group 3, the degree of analgesia achieved was similarly satisfactory in all other groups. There was no respiratory depression developed in either group. Motor block was minimal or absent in all groups. The incidence of nausea and pruritus was significant less in group 3 and group 4. In conclusion, the continuous infusion of dilute bupivacaine with fentanyl provides synergistic analgesia with minimal side effects.
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PMID:Comparison of continuous epidural infusion of fentanyl and fentanyl-bupivacaine for post cholecystectomy pain control. 235 68

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

Initial studies have suggested that oral transmucosal fentanyl citrate (OTFC) in a dose of 15-20 micrograms/kg may be a safe and effective preanesthetic medication in children and adults, but this has not been demonstrated in a randomized, double-blind fashion. The purpose of this study was to determine in a randomized, double-blind manner, the efficacy of a lollipop containing fentanyl citrate as a preanesthetic medication before surgery in children. Forty health ASA physical status 1 or 2 children 3-12 yr of age were divided randomly and in double-blind fashion into two groups. Group 1 received the lollipop containing OTFC and group 2 received a placebo lollipop. An appropriate size lollipop was chosen so that if the patient received fentanyl, the total dose would be 15-20 micrograms/kg. Anxiety, sedation, and separation scores were assessed preoperatively and ease of induction was rated. Oxygen saturation and respiratory rate were monitored. Time intervals from preanesthetic to induction and from recovery room (PACU) admission to discharge were noted. Recovery room behavior was assessed upon admission and discharge. Complications and the need for postoperative opioids were noted. OTFC produced significantly more sedation and less anxiety compared with that following placebo. Respiratory rate was significantly decreased in the OTFC group, but oxygen saturation was not significantly different between groups. Anxiety and separation scores and the quality of induction were better in the OTFC group. There was a higher incidence of nausea and pruritus in the fentanyl group. OTFC did not prolong the PACU stay.
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PMID:Preanesthetic medication in children: a comparison of oral transmucosal fentanyl citrate versus placebo. 267


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