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Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine.
Can J Anaesth. 2000 Jan; 47(1):33-7.CJ

Abstract

PURPOSE

To determine whether epidural naloxone preserved analgesia while minimizing side effects caused by epidural morphine.

METHODS

Eighty patients undergoing combined epidural and general anesthesia for hysterectomy were randomly assigned to one of four groups. All received 2 mg epidural morphine bolus one hour before the end of surgery and a continuous epidural infusion was started containing 4 mg morphine in 100 ml bupivacaine 0.125% with either no naloxone (Group 1, n = 20), 0.083 microg x kg(-1) x hr(-1) of naloxone (Group 2, n = 20), 0.125 microg x kg(-1) x hr(-1) of naloxone (Group 3, n = 20) or 0.167 microg x kg(-1) x hr(-1) of naloxone (Group 4, n = 20). Analgesia and side effects were evaluated by blinded observers.

RESULTS

The combination of epidural morphine and bupivacaine provided good analgesia. Eight hours after the end of surgery, the pain score in the group receiving the highest dose of naloxone was lower than in the control group (VAS 1.2 vs. 2.0, P<0.05) but there was less pruritus in the high-dose naloxone group (itching score 1.3 vs. 1.9, P<0.05). Pain scores were no different in any of the naloxone groups from the control group. Itching was less in both of the higher dose naloxone groups (P<0.05 at 8, 16, and 32 hours). The incidence of vomiting in the control group was 40% vs. 5% for high dose naloxone group (P<0.05).

CONCLUSIONS

Epidural naloxone reduced morphine-induced side effects in dose-dependent fashion without reversal of the analgesic effect.

Authors+Show Affiliations

Choi JH
Department of Anesthesiology, Kangnam Saint Mary's Hospital, Seoul, Korea.
Lee J
No affiliation info available
Choi JH
No affiliation info available
Bishop MJ
No affiliation info available

MeSH

AdultAnalgesia, EpiduralAnalgesics, OpioidBupivacaineDose-Response Relationship, DrugFemaleHumansMiddle AgedMorphineNaloxoneNarcotic AntagonistsNauseaPruritus

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

10626715

Citation

Choi, J H., et al. "Epidural Naloxone Reduces Pruritus and Nausea Without Affecting Analgesia By Epidural Morphine in Bupivacaine." Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, vol. 47, no. 1, 2000, pp. 33-7.
Choi JH, Lee J, Choi JH, et al. Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine. Can J Anaesth. 2000;47(1):33-7.
Choi, J. H., Lee, J., Choi, J. H., & Bishop, M. J. (2000). Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, 47(1), 33-7.
Choi JH, et al. Epidural Naloxone Reduces Pruritus and Nausea Without Affecting Analgesia By Epidural Morphine in Bupivacaine. Can J Anaesth. 2000;47(1):33-7. PubMed PMID: 10626715.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine. AU - Choi,J H, AU - Lee,J, AU - Choi,J H, AU - Bishop,M J, PY - 2000/1/8/pubmed PY - 2000/1/8/medline PY - 2000/1/8/entrez SP - 33 EP - 7 JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie JO - Can J Anaesth VL - 47 IS - 1 N2 - PURPOSE: To determine whether epidural naloxone preserved analgesia while minimizing side effects caused by epidural morphine. METHODS: Eighty patients undergoing combined epidural and general anesthesia for hysterectomy were randomly assigned to one of four groups. All received 2 mg epidural morphine bolus one hour before the end of surgery and a continuous epidural infusion was started containing 4 mg morphine in 100 ml bupivacaine 0.125% with either no naloxone (Group 1, n = 20), 0.083 microg x kg(-1) x hr(-1) of naloxone (Group 2, n = 20), 0.125 microg x kg(-1) x hr(-1) of naloxone (Group 3, n = 20) or 0.167 microg x kg(-1) x hr(-1) of naloxone (Group 4, n = 20). Analgesia and side effects were evaluated by blinded observers. RESULTS: The combination of epidural morphine and bupivacaine provided good analgesia. Eight hours after the end of surgery, the pain score in the group receiving the highest dose of naloxone was lower than in the control group (VAS 1.2 vs. 2.0, P<0.05) but there was less pruritus in the high-dose naloxone group (itching score 1.3 vs. 1.9, P<0.05). Pain scores were no different in any of the naloxone groups from the control group. Itching was less in both of the higher dose naloxone groups (P<0.05 at 8, 16, and 32 hours). The incidence of vomiting in the control group was 40% vs. 5% for high dose naloxone group (P<0.05). CONCLUSIONS: Epidural naloxone reduced morphine-induced side effects in dose-dependent fashion without reversal of the analgesic effect. SN - 0832-610X UR - https://www.unboundmedicine.com/medline/citation/10626715/Epidural_naloxone_reduces_pruritus_and_nausea_without_affecting_analgesia_by_epidural_morphine_in_bupivacaine_ L2 - https://doi.org/10.1007/BF03020728 DB - PRIME DP - Unbound Medicine ER -