The impact of intraoperative propofol administration in the prevention of postoperative pruritus induced by epidural morphine

Background and objective: We examined the efficacy of intraoperative propofol administration to prevent pruritus induced by epidural morphine. Methods: Seventy patients ASA I–II undergoing combined epidural and general anaesthesia for hysterectomy were randomly assigned to two groups, Group P where anaesthesia was induced with propofol and fentanyl and maintained with propofol‐nitrous oxide and Group S in which anaesthesia was induced with thiopental and fentanyl and maintained with sevoflurane‐nitrous oxide. All patients received a ropivacaine epidural bolus with 3 mg morphine 1 h before the end of surgery. The incidence and severity of pruritus were evaluated every 4 h for the first 12 h postoperatively by blinded observers. Results: The total incidence of pruritus was significantly higher (P = 0.024) in Group S (65.6%) compared to Group P (29%) between 4 and 8 h postoperatively. There were also significantly more patients (P = 0.03) reporting severe pruritus in Group S (22%) compared to Group P (0). Conclusion: Propofol‐based general anaesthesia compared to thiopental–sevoflurane‐based anaesthesia reduces the incidence and severity of pruritus induced by a single injection of 3 mg epidural morphine with ropivacaine.

[1]  D. Harmon,et al.  Neuraxial opioid-induced pruritus: a review. , 2003, Journal of clinical anesthesia.

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

[3]  M. L. Horta,et al.  The inhibition of epidural morphine-induced pruritus by epidural droperidol. , 2000, Anesthesia and analgesia.

[4]  Wei-Zen Sun,et al.  Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. , 2000 .

[5]  M. L. Horta,et al.  The Inhibition of Epidural Morphine-induced Pruritus by Epidural Droperidol , 2000 .

[6]  Y. Beilin,et al.  Subhypnotic Doses of Propofol Do not Relieve Pruritus Induced by Intrathecal Morphine After Cesarean Section , 1998, Anesthesia and analgesia.

[7]  P. Grattidge.  Nausea and vomiting after major arthroplasty with spinal anaesthesia including morphine: a randomised trial of subhypnotic propofol infusion as prophylaxis , 1998, Acta anaesthesiologica Scandinavica.

[8]  C. Kearns,et al.  The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for Caesarean section , 1997, Anaesthesia.

[9]  P. Glass,et al.  Double-blind, Randomized Comparison of Ondansetron and Intraoperative Propofol to Prevent Postoperative Nausea And Vomiting , 1996, Anesthesiology.

[10]  L. Lindgren,et al.  Effects of sub-hypnotic doses of propofol on the side effects of intrathecal morphine. , 1994, British journal of anaesthesia.

[11]  P. Suter,et al.  Epidural-morphine-induced pruritus: propofol versus naloxone. , 1994, Anesthesia and analgesia.

[12]  P. Suter,et al.  The Nonhypnotic Therapeutic Applications of Propofol , 1994, Anesthesiology.

[13]  A. Borgeat,et al.  Subhypnotic doses of propofol relieve pruritus induced by epidural and intrathecal morphine. , 1993, Anesthesiology.

[14]  J. Ballantyne,et al.  Itching after epidural and spinal opiates , 1988, Pain.

[15]  A. C. Primavesi.  ▪ Prophylactic Intravenous Ondansetron Reduces the Incidence of Intrathecal Morphine-Induced Pruritus in Patients Undergoing Cesarean Delivery: , 2000 .