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

Epidural morphine has been used more and more to provide long-lasting postoperative analgesia after cesarean delivery. However, the incidence of pruritus (20%-93%) and nausea (17%-60%) detract from the usefulness of epidural morphine. The purpose of this study was to evaluate, in 30 patients having epidural anesthesia for cesarean delivery, the analgesic efficacy and side effects when a combination of epidural morphine, a mu-receptor agonist, and butorphanol, a mu-receptor antagonist and kappa-receptor agonist, was administered. After clamping of the umbilical cord, patients received 4 mg epidural morphine with 3 mL of normal saline (group 1), 4 mg epidural morphine with 1 mg butorphanol and 2 mL of normal saline (group 2), or 4 mg epidural morphine with 3 mg butorphanol (group 3). Patients were monitored for 24 h after administration of the study medications. There were no significant differences between the groups in visual analogue pain scores, time to first analgesic request, respiratory rate, or Trieger dot test performance in the 24 h immediately after these epidural injections. There were three patients in group 1 and one patient in group 2 who experienced oxygen saturations less than 90%. (No patients in group 3 developed an oxygen saturation less than 92%.) The patients in group 3 did not require treatment for pruritus or nausea, a response significantly different (P less than 0.001 and P less than 0.05, respectively) from group 1 or group 2.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Epidural morphine with butorphanol for postoperative analgesia after cesarean delivery. 198 77

Epidural butorphanol 1, 2 and 4 mg were compared with morphine, 5 mg, for postoperative analgesia in 92 consenting, healthy, term parturients who had undergone Caesarean section under epidural lidocaine anaesthesia in a randomized double-blind study. Postoperative pain was assessed using a visual analogue scale and recorded with heart rate, blood pressure and respiratory rate. The demographic characteristics, and the incidences of primary and repeat Caesarean sections, were not different among the four treatment groups. At 15, 30, 45 and 60 min after treatment the median pain scores following butorphanol were similar and lower than those following morphine (P less than 0.05). Calculated median percentage pain relief values for butorphanol were higher than morphine at each of these times (P less than 0.05). At 90 min and 2 hr the pain scores and pain relief values were similar. Beyond 45 min the number of patients requesting supplemental medication and dropping out of the study increased progressively in both the butorphanol and morphine treated patients. The attrition profiles for butorphanol were different from morphine (P less than 0.01). The median time in the study was greater than 24 hr for morphine, and 3, 2.5 and 4 hr for butorphanol, 1, 2 or 4 mg, respectively. No patient developed a clinically important change in heart rate or blood pressure, and none experienced a decrease in respiratory rate below 12 breaths.min-1. One of 69 patients (1.4 per cent) who received butorphanol developed pruritus compared with ten (43 per cent) of 23 patients who received morphine. The global assessments of the adequacy of analgesia were indistinguishable between morphine and butorphanol. Epidural butorphanol provides safe, effective postoperative analgesia, has a prompt onset, and a limited duration.
 ...
PMID:Post-caesarean section analgesia: a comparison of epidural butorphanol and morphine. 198 36

Epidural infusions of 10 micrograms/mL fentanyl combined with low-dose bupivacaine (0.1%) were compared with epidural infusions of fentanyl alone for postoperative analgesia after total knee joint replacement. There were no detectable differences between the two groups in analgesia (visual analogue scale ranging between 15 and 40 mm), infusion rates (which averaged 7-9 mL/h), or serum fentanyl levels (which reached 1-2 ng/mL). The incidence of side effects, including nausea, vomiting, and pruritus, was also similar. Of the patients receiving fentanyl and low-dose bupivacaine, one developed a transient unilateral motor and sensory loss, and one developed significant hypotension and respiratory depression. The addition of low-dose bupivacaine does not improve epidural fentanyl infusion analgesia after knee surgery and may increase morbidity.
 ...
PMID:Low-dose bupivacaine does not improve postoperative epidural fentanyl analgesia in orthopedic patients. 186 42

To compare the efficacy and side effects of 0.2 mg intrathecal (IT) morphine with 0.125% epidural bupivacaine, 62 women in labor were studied. They were randomly divided into three groups: group 1 (n = 20) received IT morphine; group 2 (n = 22) received epidural bupivacaine; and group 3 (n = 20) received a combination of both using a combined spinal-epidural (CSE) technique. According to a visual analogue scale for assessing analgesia, neither IT 0.2 mg morphine nor 10 ml 0.125% epidural bupivacaine was effective in producing adequate pain relief in labor, whereas the combination produced excellent analgesia. The use of IT morphine significantly reduced the dosage requirement of epidural bupivacaine. The incidence of nausea, vomiting, and pruritus was significantly higher when IT morphine had been administered, whereas that of urinary retention did not differ. No serious respiratory depression occurred in any of the patients. When the course of labor was studied, the prior use of IT morphine significantly prolonged the duration of the first stage of labor and the total duration of labor. We conclude that the administration of 0.2 mg IT morphine in combination with epidural administration of 0.125% bupivacaine provides better analgesia than the administration of either drug alone.
 ...
PMID:Intrathecal morphine 0.2 mg versus epidural bupivacaine 0.125% or their combination: effects on parturients. 200 53

We have compared the analgesic effects of three epidural infusions in a randomised, double-blind study of 61 mothers in labour. An initial dose of bupivacaine 0.5% 8 ml was followed by either bupivacaine 0.125%, bupivacaine 0.125% with diamorphine 0.0025% or bupivacaine 0.125% with fentanyl 0.0002%. All infusions were run at a rate of 7.5 ml/hour. Analgesia was significantly better in both the groups receiving opioids. Diamorphine was shown to be the more effective supplement to bupivacaine. The 5% incidence of pruritus in the opioid groups was less than that reported by earlier authors.
 ...
PMID:Epidural infusion of diamorphine with bupivacaine in labour. A comparison with fentanyl and bupivacaine. 201 89

Fifty-three unpremedicated outpatients undergoing elective extracorporeal shock wave lithotripsy using an unmodified Dornier HM-3 lithotriptor received one of two different intravenous sedation-analgesia techniques. Both intravenous midazolam-alfentanil and fentanyl-propofol techniques produced conditions comparable to those achieved with epidural anesthesia during immersion lithotripsy. Of the two sedative-analgesic techniques, midazolam-alfentanil was associated with greater intraoperative amnesia (81% vs 38%), whereas fentanyl-propofol produced less cardiorespiratory depression and fewer postoperative side effects (e.g., pruritus). Compared with a standard epidural anesthesia technique, the mean anesthesia and recovery times were significantly shorter with the two intravenous sedation-analgesia techniques (57-62 min vs 105 min and 143-147 min vs 199 min, respectively). These data suggest that combinations of either midazolam and alfentanil or fentanyl and propofol are viable alternatives to epidural anesthesia for outpatient immersion lithotripsy.
 ...
PMID:Comparison of intravenous sedative-analgesic techniques for outpatient immersion lithotripsy. 201 18

The authors report their experience with low doses (0.007-0.015 mg/kg), moderate doses (0.016-0.025 mg/kg), and high doses (0.026-0.035 mg/kg) of intrathecal morphine for postoperative analgesia after selective dorsal root rhizotomy surgery in 50 children, aged 3 to 12 years. After closure of the dura, a single dose of preservative-free morphine was injected into the subarachnoid space, and patients were assessed for 48 hours for level of comfort and side effects. The three doses of morphine provided equivalent analgesia and similar side effects. The duration of postoperative analgesia ranged from 3 to 48 hours (mean, 12.2 +/- 9.5 h). Common side effects were limited to nausea and vomiting (42%) and mild facial pruritus. No patient experienced late respiratory depression or generalized pruritus. The authors conclude that low doses of intrathecal morphine is as effective as moderate or high doses of morphine for reducing pain in the immediate postoperative period. Intrathecal morphine provides excellent analgesia after selective dorsal rhizotomy.
 ...
PMID:Intrathecal morphine for postoperative analgesia in children after selective dorsal root rhizotomy. 175 15

Sixty unpremedicated outpatients undergoing elective extracorporeal shock wave lithotripsy using an unmodified Dornier HM-3 lithotriptor were randomly assigned to receive an intravenous infusion of either alfentanil or ketamine as an adjuvant to midazolam for sedation and analgesia. Although both drug regimens allowed the maximal number of shock waves and energy level, the alfentanil group had significantly better calculi fragmentation (78% vs. 50% of patients with fragments less than 2 mm). Ketamine infusion provided superior intraoperative cardiorespiratory stability; however, it was associated with more disruptive movements (22 vs. 5) and dreaming (35% vs. 5%) during the procedure (P less than 0.05). Postoperatively, confusion also occurred more frequently in the ketamine-treated patients (31% vs. 5%, P less than 0.05). Alfentanil infusion was associated with more episodes of hemoglobin oxygen desaturation to less than 90% (12 vs. 2, P less than 0.05), itching (23% vs. 4%, P less than 0.05), and ability to recall intraoperative events (45% vs. 12%, P less than 0.05). The incidence of postoperative nausea was decreased (not significantly) in the alfentanil group (32% vs. 54%). The mean anesthesia time was similar in both groups; however, discharge times (means +/- standard deviations) were shorter in the alfentanil group (142 +/- 42 min vs. 161 +/- 31 min, P = 0.05). These data suggest that although both techniques proved effective for anesthesia in outpatients undergoing immersion lithotripsy, alfentanil is superior to ketamine as part of a sedative-analgesic technique because of the improved recovery profile and calculi fragmentation.
 ...
PMID:Comparison of alfentanil and ketamine infusions in combination with midazolam for outpatient lithotripsy. 204 57

A double-blind, placebo-controlled study of 60 patients post cesarean delivery was conducted to determine whether nalbuphine reverses the side effects of pruritus and respiratory depression associated with epidurally administered morphine. Patients randomly received either three doses of intravenous nalbuphine or the equivalent volume of saline. Vital signs, sedation, pain, pruritus and oxygen saturation were assessed hourly for 18 hours. There were no statistically significant differences in demographic data, sedation level, pain scores or analgesia requirements. Only three patients had no pruritus, one who received nalbuphine and two who received saline. Five patients had respiratory depression (respiratory rate lower than 10 BPM or oxygen saturation less than 90%); three occurred in the nalbuphine group and two in the saline group. Although theoretically advantageous, nalbuphine, as administered in this study of obstetric patients, offered no prophylactic benefit against the pruritus associated with epidural morphine. Its benefit with regard to respiratory depression remains unclear.
 ...
PMID:Nalbuphine pretreatment in cesarean section patients receiving epidural morphine. 204 31

Forty cancer patients were randomly assigned to two groups (n = 20). All had incapacitating pain unresponsive to the usual non opioid analgesic drugs. An epidural catheter was set up at the level of the most painful metamere, and made to pass subcutaneously so as to exit either in the supraclacicular fossa, or on the patient's flank. At T0, the patients were given 4 mg morphine hydrochloride diluted in 10 ml normal saline. Thirty min later, patients in the naloxone group (group N) were given a 0.4 mg bolus, followed by a constant rate infusion of 5 micrograms.kg-1.h-1, of naloxone hydrochloride during 18 h. Patients in group P (placebo) were given normal saline instead. The degree of pain was studied with a visual analogue scale and analgesia was assessed by a clinician on a five point scale. These two parameters were obtained half an hour after the injection of morphine and 2, 4, 6 and 24 hours later. At the same time, the patients were questioned about adverse side-effects: nausea, vomiting, pruritus, dysuria, urinary retention. Respiratory depression was assessed clinically and biologically (blood gas measurements at the afore mentioned times). Heart rate, systolic and diastolic blood pressure were also measured. There was no statistically significant difference between the groups in quality and duration of analgesia. Pain reached its lowest level 4 h after the injection of morphine, returning to half its original value at the 24th h. This was also true for the incidence of nausea (11 in group N, 5 in group P), vomiting (3 in both groups), and urinary retention (6 in group P, 5 in group N).(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Prevention by naloxone of adverse effects of epidural morphine analgesia for cancer pain]. 205 46


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>