Preoperative Gabapentin Prevents Intrathecal Morphine-Induced Pruritus After Orthopedic Surgery

BACKGROUND:Pruritus is the most common side effect of intrathecal morphine. Gabapentin is an anticonvulsant and had been reported to be effective in some chronic pruritus conditions. Its effect in intrathecal morphine-induced pruritus has not yet undergone an evaluation. METHODS:We randomly allocated 86 patients scheduled for lower limb surgery under spinal anesthesia into two equal groups that received either gabapentin 1200 mg or placebo 2 h before operation in a prospective, double-blind manner. All patients received an intrathecal injection of 15 mg of 0.5% isobaric bupivacaine and 0.2 mg preservative-free morphine. Pruritus was evaluated at 3, 6, 9, 12, and 24 h after intrathecal morphine administration. RESULTS:The incidence of pruritus was significantly more frequent in the placebo group compared with the gabapentin group (77.5% vs 47.5%; P = 0.01). The onset time of pruritus in the gabapentin group (6.2 ± 1.8 h) was significantly delayed compared with that in the placebo group (3.1 ± 0.8 h) (P < 0.0001). The severity of pruritus was significantly more in the placebo group compared with the gabapentin group at 3 and 6 h after intrathecal morphine injection. CONCLUSION:Preoperative gabapentin prevents pruritus induced by intrathecal morphine in patients undergoing lower limb surgery with spinal anesthesia.

[1]  R. Dubner.  A bibliometric analysis of the Pain journal as a representation of progress and trends in the field , 2009, Pain.

[2]  F. McGlone,et al.  Chronic itch and chronic pain: Analogous mechanisms , 2007, Pain.

[3]  J. Eisenach,et al.  Oral Gabapentin Activates Spinal Cholinergic Circuits to Reduce Hypersensitivity after Peripheral Nerve Injury and Interacts Synergistically with Oral Donepezil , 2007, Anesthesiology.

[4]  J. Eisenach,et al.  Gabapentin Activates Spinal Noradrenergic Activity in Rats and Humans and Reduces Hypersensitivity after Surgery , 2007, Anesthesiology.

[5]  A. Baraka,et al.  Does Ondansetron or Granisetron Prevent Subarachnoid Morphine-Induced Pruritus After Cesarean Delivery? , 2007, Anesthesia and analgesia.

[6]  M. Schmelz.  Complex interactions between pain and itch , 2006, Pain.

[7]  S. Ständer,et al.  Chronic itch and pain—Similarities and differences , 2006, European journal of pain.

[8]  M. Steinhoff,et al.  The neurobiology of itch , 2006, Nature Reviews Neuroscience.

[9]  K. Korttila,et al.  Ondansetron and tropisetron do not prevent intraspinal morphine‐ and fentanyl‐induced pruritus in elective cesarean delivery , 2006, Acta anaesthesiologica Scandinavica.

[10]  W Vennart,et al.  Pharmacological modulation of pain-related brain activity during normal and central sensitization states in humans. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[11]  P. Yesudian,et al.  Efficacy of gabapentin in the management of pruritus of unknown origin. , 2005, Archives of dermatology.

[12]  C. Simopoulos,et al.  Prophylactic Intravenous Ondansetron and Dolasetron in Intrathecal Morphine-Induced Pruritus: A Randomized, Double-Blinded, Placebo-Controlled Study , 2005, Anesthesia and analgesia.

[13]  J. Rathmell,et al.  The Role of Intrathecal Drugs in the Treatment of Acute Pain , 2005, Anesthesia and analgesia.

[14]  S. Hunt,et al.  Spinal-supraspinal serotonergic circuits regulating neuropathic pain and its treatment with gabapentin , 2005, Pain.

[15]  G. Yosipovitch,et al.  Pharmacologic advances in the systemic treatment of itch , 2005, Dermatologic therapy.

[16]  A. Vaglio,et al.  Gabapentin for uraemic pruritus. , 2005, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[17]  T. Yoldas,et al.  Gabapentin therapy for pruritus in haemodialysis patients: a randomized, placebo-controlled, double-blind trial. , 2004, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[18]  I. Coulson,et al.  Brachioradial pruritus: response to treatment with gabapentin , 2004, The British journal of dermatology.

[19]  S. Charuluxananan,et al.  Nalbuphine Versus Ondansetron for Prevention of Intrathecal Morphine-Induced Pruritus After Cesarean Delivery , 2003, Anesthesia and analgesia.

[20]  Y. Gürkan,et al.  Prophylactic Ondansetron Reduces the Incidence of Intrathecal Fentanyl-Induced Pruritus , 2002, Anesthesia and analgesia.

[21]  M. Tramèr,et al.  Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials , 2001, European journal of anaesthesiology.

[22]  Frank Munz,et al.  Central activation by histamine-induced itch: analogies to pain processing: a correlational analysis of O-15 H2O positron emission tomography studies , 2001, Pain.

[23]  R. Taylor.  Multiple sclerosis potpourri. Paroxysmal symptoms, seizures, fatigue, pregnancy, and more. , 1998, Physical medicine and rehabilitation clinics of North America.

[24]  Hermann O. Handwerker,et al.  Specific C-Receptors for Itch in Human Skin , 1997, The Journal of Neuroscience.

[25]  A. Dickenson,et al.  Gabapentin, ineffective in normal rats, markedly reduces C‐fibre evoked responses after inflammation , 1997, Neuroreport.

[26]  A. Vaglio,et al.  Gabapentin in the treatment of uremic itch: an index case and a pilot evaluation. , 2005, Journal of nephrology.

[27]  M. Schmelz.  A neural pathway for itch , 2001, Nature Neuroscience.

[28]  A. Craig,et al.  Spinothalamic lamina I neurons selectively sensitive to histamine: a central neural pathway for itch , 2001, Nature Neuroscience.