Abstract
Purpose
To compare both the efficacy and cost of nalbuphine and diphenhydramine in the treatment of intrathecal morphine-induced pruritus following Caesarean section.
Methods
Eighty patients, undergoing elective Caesarean section under spinal anaesthesia, were randomized, in a prospective, double-blind trial, to receive either nalbuphine (Group NAL) or diphenhydramine (Group DIP) for the treatment of SAB morphine-induced pruritus. All patients received an intrathecal injection of 10–12 mg hyperbaric bupivacaine 0.75% and 200 μg preservative free morphine. Postoperative pruritus was assessed, using a visual analogue scale (VAS), for 24 hr. Pruritus treatment was administered upon patient request and by a nurse blinded to the treatment given. Patients who failed to respond to three doses of the study drug were deemed treatment failures. Patient satisfaction was assessed with a questionnaire given 24 to 48 hr after surgery. Direct drug costs were calculated based on the pharmacy provision costs as of April 1996.
Results
Eighty patients were enrolled and 45 requested treatment for pruritus. Patients treated with NAL (n = 24) were more likely to achieve a VAS score of zero with treatment (83% vs 43%, P < 0.01), had a higher ΔVAS following treatment (4 ± 2 vs 2 ± 2, P < 0.003), and experienced fewer treatment failures (4% vs 29%, P < 0.04), than those treated with DIP (n = 21). Group NAL patients were also more likely to rate their pruritus treatment as being good to excellent (96% vs 57%, P < 0.004). Direct drug costs were higher for NAL than for DIP ($6.4 ± 3.1 vs $ 1.7 ± 0.7, respectively, P < 0.0001).
Conclusion
Nalbuphine is more effective than diphenhydramine in relieving pruritus caused by intrathecal morphine and the cost differences are small.
Résumé
Objectif
Comparer l’efficacité et le coût de la nalbuphine avec ceux de la diphenhydramine administrée après la césarienne comme traitement du prurit provoqué par la morphine sous-arachnoïdienne.
Méthodes
Dans cette étude prospective en double aveugle, 80 parturientes opérées pour une césarienne non urgente sous rachianesthésie ont été réparties au hasard pour recevoir comme traitement du prurit provoqué par la morphine soit de la nalbuphine (groupe NAL), soit de la diphenhydramine (groupe DIP). Toutes les patientes ont reçu une injection sous-arachnoïdienne de 10–12 mg de bupivacaïne 0,75% hyperbare avec 200 μg de morphine sans préservatif. Une échelle visuelle analogique (ÉVA) a servi à évaluer l’intensité du prurit postopératoire pendant 24 h. Le traitement antiprurigineux a été administré à la demande de la patiente et par une infirmière ignorant la nature du traitement. On considérait le traitement comme un échec en l’absence de réponse àtrois doses de la drogue étudiée. La satisfaction de la patiente était évaluée avec un questionnaire administré 24 à 48 h après la chirurgie. Les coûts d’approvisionnement de la pharmacie en avril 1996 représentaient les coûts directs des produits utilisés.
Résultats
Quarante-cinq des 80 participantes à l’étude ont demandé un traitement antiprurigineux. Les patientes traitées avec NAL (n=24) avaient plus de chance d’obtenir la cote zéro sur l’ÉVA (83% vs 43%, P < 0,01), avaient un ΔÉVA plus élevé après traitement (4 ± 2 vs 2 ± 2, P < 0,003) et ont subi moins d’échecs thérapeutiques (4% vs 29%, P < 0,04) que celles du groupe DIP (n = 21). Le groupe NAL avait une plus forte tendance à juger le traitement antiprurigineux de bon à excellent (96% vs 57%, P < 0,004). Les coûts directs étaient plus élevés pour NAL que pour DIP (6,4$ ± 3,1 vs 1,7$ ± 0,7, P < 0,0001).
Conclusion
La nalbuphine soulage plus efficacement le prurit provoqué par la morphine sous-arachnoïdienne que la diphenhydramine et la différence des coûts est minime.
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Alhashemi, J.A., Crosby, E.T., Grodecki, W. et al. Treatment of intrathecal morphine-induced pruritus following Caesarean section. Can J Anaesth 44, 1060–1070 (1997). https://doi.org/10.1007/BF03019227
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DOI: https://doi.org/10.1007/BF03019227