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

Morphine sulphate 5 mg and placebo administered epidurally after caesarean section under epidural analgesia were compared in a double-blind fashion. Morphine was significantly superior to placebo for pain relief, duration of pain relief, and reduction of parenteral narcotic requirements. Pruritus was the most commonly encountered side-effect. There was no statistical difference between morphine and placebo in the incidence of urinary catheterisation, vomiting, nausea, dizziness or drowsiness. No serious respiratory depression requiring treatment was observed.
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PMID:Epidural morphine after caesarean section. 686 75

Morphine was administered by the peridural route, in doses of 2 to 6 mg, without and with adrenalin 1/200,000, to 197 patients undergoing various surgical procedures under peridural anesthesia, with a view to lower post-operative pain. The evaluation of the effect was estimated subjectively, with the aid of a visual analogue scale and was also based on the demand for analgesia. The latency time appeared to be long: 1 hour. The overall mean duration of action is 16.25 h. The efficiency is related to the type of operation: 2-3 mg doses injected after the operation are effective in only about 50% of laparotomies and orthopedic procedures, whereas with soft tissue surgery or ano-perineal and gynecological surgery efficiency is higher (83.33% and 88.23% respectively). The injection given during the operation is more efficient, but urinary retention also seems to increase. No respiratory, circulatory or motor depression has been observed. The most untoward effects are nausea and vomiting (32.99%), urinary retention (25.40%), itching (20.30%). Combination with adrenalin does not improve the efficiency of the analgesia and secondary effects tend to be enhanced, especially urinary retention (53.57%). The spinal mediation of the effects of morphine and its access to supraspinal structures are discussed.
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PMID:Peridural administration of morphine, with or without adrenalin, for postoperative analgesia. 689 18

The anatomical basis for facial itch after epidural morphone is outlined. CNS nuclear events which reactivate latent herpes simplex and immune inhibition resulting in maternal mouth vesicles or neonatal infections are described. Morphine is hypothesized to affect these processes and facial itch is only a marker, not a trigger of this trigeminal opioid activity.
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PMID:A review of anatomical and immunological links between epidural morphine and herpes simplex labialis in obstetric patients. 748 31

Using a randomized, double-blind, placebo-controlled design, we have investigated, in 40 patients undergoing major abdominal surgery, the effect of oral clonidine 300 micrograms, 1 h before and 12 h after surgery on postoperative morphine requirements (evaluated by PCA). During the 24 h of the study, pain scores measured every 6 h did not differ significantly. Morphine requirements tended to be reduced in the clonidine group but the difference was not significant. There were no significant differences also in mean arterial pressure, ventilatory frequency and the incidence of pruritus and nausea. Heart rate was significantly lower until 18 h after surgery and sedation was significantly more pronounced in patients receiving clonidine. We cannot recommend routine oral administration of clonidine before surgery to improve postoperative analgesia.
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PMID:Addition of oral clonidine to postoperative patient-controlled analgesia with i.v. morphine. 819 4

The medullary dorsal horn (MDH), the medullary homolog of the spinal dorsal horn, is a site where opioid-receptor agonists can act at opioid receptors to produce pronounced facial scratching, the behavioral correlate of pruritus. In the present study, after a 10-min baseline period, morphine (5.0 micrograms) was micro-injected into the MDH of monkeys. Behavior was videotaped and facial scratches were counted by two independent raters. Morphine greatly increased facial scratching behavior, which is consistent with previous findings where mu-opioid receptor agonists microinjected into the MDH have been to induce dose-dependent, naloxone-reversible facial scratching in monkeys. In the current research, intramuscular (IM) administration of the opioid-receptor antagonist, naloxone (0.5 mg/kg), reversed this MDH morphine-induced scratching. Additionally, IM morphine (1.0 mg/kg) produced a substantial reduction in facial scratching behavior. Scratching behavior continued at a high rate after injection of saline (0.1 mL/kg, IM). These findings support the hypothesis that morphine has both pruragenic and antipruragenic activity, depending on the site of action.
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PMID:Multiple effects of morphine on facial scratching in monkeys. 821 29

The efficacy and side effects of epidural bolus injection of 4 mg of morphine in a volume of 2 ml, 10 ml, or 20 ml (groups I, II and III) for postoperative analgesia after caesarean section (60 patients) were evaluated. All patients had epidural anaesthesia established up to T4 level with 0.5% bupivacaine 18-20 ml, supplemented with 2% lidocaine with adrenaline, when necessary. Morphine 4 mg in either of the three volumes was injected through the epidural catheter in random order after delivery of the baby. Six patients in each group reported no pain during the 24-h follow-up period. No additional pain medication during the 24 h after surgery was required in 11, 14 and 10 patients in groups I, II and III, respectively. Most of the others managed with the addition of a single dose of rectal ketoprofen. There were no differences in analgesic therapy between the groups. Pruritus was the most common adverse effect (18/20, 19/20 and 18/20 in groups I, II and III, respectively). 10/20, 12/20 and 14/20 (N.S.) patients had nausea and vomiting in groups I, II and III, respectively. Metoclopramide, prescribed for persistent nausea, was given to 4/20 patients in group I, 6/20 patients in group II and 9/20 patients in group III (N.S.). After removal of the urinary catheter 7/20 patient in group III required carbachol for urinary retention compared to 3/20 and 4/20 patients in groups I and II (N.S.).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Epidural analgesia with 4 mg of morphine following caesarean section: effect of injected volume. 827 52

In a double-blind placebo-controlled cross-over study the effects of epidural morphine (4 mg) on somatosensory functions were investigated in 10 healthy volunteers. Detection, pain detection and pain tolerance thresholds to thermal, mechanical and electrical stimuli as well as magnitude rating of short-lasting stimuli of the same modalities were monitored before and for 10 h after epidural administration of 4 mg of morphine or saline. Epidural morphine induced a naloxone-reversible (0.1 mg/kg, i.v.) increase in pain detection threshold to heat and mechanical stimuli and in pain tolerance threshold to heat, mechanical and electrical stimuli. Morphine induced a more pronounced increase in the pain tolerance than in the pain detection threshold. Magnitude rating of short-lasting radiant heat (argon laser) stimuli were reduced by epidural morphine in comparison to placebo while there was no significant difference between the effects of morphine and placebo on magnitude rating of short-lasting mechanical and electrical stimuli. The warm detection threshold was increased (naloxone reversible) by morphine. Segmental distribution of pruritus was reported by 7 subjects following epidural morphine which was replaced by a short-lasting burning sensation following naloxone administration. Naloxone (0.1 mg/kg) preceeded by placebo did not change somatosensory functions. These results indicate that the somatosensory effect of epidural morphine is dependent on the types of afferent fibres activated as well as on the duration and intensity of the stimulus.
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PMID:Quantitative sensory examination during epidural anaesthesia and analgesia in man: effects of morphine. 844 40

The results of postoperative epidural administration of saline solution (a placebo), morphine, methylprednisolone, and a combination of morphine and methylprednisolone for the reduction of pain after an operation for spinal stenosis or a herniated intervertebral disc were compared in a prospective, randomized blinded study. Epidural administration of morphine and methylprednisolone--either alone or in combination--significantly reduced the need for analgesia after an operation for spinal stenosis (p < 0.05) but not after an operation for a herniated intervertebral disc. Morphine and methylprednisolone did not have an addictive effect on the reduction of pain. Itching was significantly more common in the patients who had received morphine than in those who had received the placebo (p = 0.04). Although urinary retention was more frequent after the use of morphine than after the use of the placebo, the difference was not significant with the size of the sample that was analyzed (p = 0.25).
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PMID:Epidural administration of methylprednisolone and morphine for pain after a spinal operation. A randomized, prospective, comparative study. 855 Jun 48

It has been proposed that opioids act at the level of the medulla to produce facial pruritus. Supporting this hypothesis, microinjection of mu-opioid receptor agonists into the medullary dorsal horn (MDH; trigeminal subnucleus caudalis) of monkeys produces facial scratching behavior. The present study sought to establish a rodent model of opioid-induced facial pruritus. To this end, morphine (0.1, 0.3 or 1.0 micrograms/0.2 microliter) or saline (0.2 microliter) was unilaterally microinjected into the MDH of male Sprague-Dawley rats. Behavior for the 20 min preceding and the 80 min after this microinjection was videotaped. Morphine produced dose-dependent increases in facial scratching behavior ipsilateral to the microinjections with the peak effect at 30-40 min after microinjection. Facial scratching continued for the entire 80 min post-microinjection test period. Morphine also produced a lesser degree of facial scratching contralateral to the microinjections. Increases in facial scratching ipsilateral to the microinjection of 0.3 microgram morphine into the MDH were attenuated by 0.4 mg/kg s.c. naloxone. These findings support the hypothesis that the MDH is a critical site of action of opioid agonists in producing facial pruritus.
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PMID:Microinjection of morphine into the rat medullary dorsal horn produces a dose-dependent increase in facial scratching. 855 43

Evidence of pre-emptive analgetic effect of opioid would offer great potential benefit to patients with postoperative pain, a better pain relief with less opioid. The aim of this double blind randomised trial was to study the effect of intramuscular morphine premedication on postoperative pain. Forty-one patients undergoing total knee arthroplasty were randomly allocated to four groups. Two groups received epidural morphine, 4 mg immediately after operation and 3 mg ten hours later, and two groups the same volume of saline. All patients had access to intravenous PCA-fentanyl. One epidural morphine and one epidural saline group (PreEpiMo and PreMo, respectively) received morphine, 0.14 mg/kg i.m. as premedication. Pain was measured with a visual analogue scale (VAS). Respiration was monitored by means of pulseoximetry, arterial blood gas analysis and rate of breathing. Morphine premedication reduced postoperative pain in the immediate postoperative period in patients with epidural placebo (PreMo), but the effect was absent in patients with PreEpiMo. Epidural morphine (EpiMo) provided stable analgesia with reduced need of PCA-fentanyl. Two patients (10%) (one in EpiMo and one in PreEpiMo) developed respiratory depression requiring naloxone treatment. The dosage of epidural morphine used in this study was a likely explanation of this depression. Nausea, vomiting, itching and urinary retention were the most frequent side effects without significant differences between the groups. In conclusion, morphine premedication had a temporary rest effect on the postoperative pain. Epidural morphine provides a better analgesia than intravenous PCA-fentanyl.
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PMID:Does morphine premedication influence the pain and consumption of postoperative analgesics after total knee arthroplasty? 890 63


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