Journal of Isfahan Medical School

Journal of Isfahan Medical School

The Effect of Intravenous Propofol or Pentazocine in Preventing Pruritus due to Intrathecal Fentanyl in Lower Limb Surgery Compared with Control Group

Document Type : Original Article (s)

Authors
Mitra Jabalameli 1
Hamid Reza Larijani 2
1 Profess, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
10.22122/jims.v36i490.9986
Abstract
Background: Using intrathecal opioid in surgery operation causes a desirable analgesic. But one of its side effects is pruritus and then, patients’ dissatisfaction. Therefore, the present study investigated the effect of intravenous propofol or pentazocine in preventing pruritus resulted from prescribed fentanyl.Methods: This was a controlled randomized double-blinded clinical trial study carried out on 150, 18-65-year-old adults, candidate for lower limb surgery under spinal analgesia, who were selected using simple random sampling method. The first 50 patients received 20 milligrams of intravenous propofol, the second 50 patients received 15 milligrams of intravenous pentazocine, and the third 50 patients received placebo, 10 minutes after analgesia. The side effects resulted from drug injection were recorded if any occurred. All the patients were under spinal anesthesia by 3 milliliters of 0.5% Marcaine, and 25 microgram fentanyl. The hemodynamic situation of patients was recorded at regular intervals before, during, and after surgery.Findings: Meaningful modifications in heart rate (HR) and mean arterial pressure (MAP) were reported in all three groups (P < 0.05), but the modifications in oxygen saturation (SaO2) were meaningless (P > 0.05). Pruritus in patients receiving propofol was relatively constant, but in control and pentazocine group, meaningful increase in pruritus was reported (P < 0.05).Conclusion: Propofol beside fentanyl in comparison to pentazocine or placebo plays more significant role in decreasing pruritus; however, pentazocine can be effective too with intrathecal opioid.
Keywords
Pentazocine
Propofol
Pruritus
Intrathecal injections
Opioids
Fentanyl
Anesthesia
Spinal
  1. Birnbach DJ, Browne IM. In: Miller RD, editor. Anesthesia for obstetrics. Miller's anesthesia.London, UK: Churchill Livingstone; 2010. p. 2215, 2219.
  2. Norris MC. Height, weight, and the spread of subarachnoid hyperbaric bupivacaine in the term parturient. Anesth Analg 1988; 67(6): 555-8.
  3. Owczuk R, Wenski W, Polak-Krzeminska A, Twardowski P, Arszulowicz R, Dylczyk-Sommer A, et al. Ondansetron given intravenously attenuates arterial blood pressure drop due to spinal anesthesia: a double-blind, placebo-controlled study. Reg Anesth Pain Med 2008; 33(4): 332-9.
  4. Sanli S, Yegin A, Kayacan N, Yilmaz M, Coskunfirat N, Karsli B. Effects of hyperbaric spinal ropivacaine for caesarean section: with or without fentanyl. Eur J Anaesthesiol 2005; 22(6): 457-61.
  5. Pourbahri M, Kashani S, Malekshoar M, Jarineshin H, Vatankhah M, Baghaee AA, et al . Comparison of median vs. paramedian techniques of spinal anesthesia in cesarean section. J Anesth Pain 2015; 6(1): 9-20. [In Persian].
  6. Bano F, Sabbar S, Zafar S, Rafeeq N, Iqbal MN, Haider S, et al. Intrathecal fentanyl as adjunct to hyperbaric bupivacaine in spinal anesthesia for caesarean section. J Coll Physicians Surg Pak 2006; 16(2): 87-90.
  7. Szarvas S, Harmon D, Murphy D. Neuraxial opioid-induced pruritus: A review. J Clin Anesth 2003; 15(3): 234-9.
  8. Rawal N, Sjostrand U, Dahlstrom B. Postoperative pain relief by epidural morphine. Anesth Analg 1981; 60(10): 726-31.
  9. Bromage PR, Camporesi EM, Durant PA, Nielsen CH. Nonrespiratory side effects of epidural morphine. Anesth Analg 1982; 61(6): 490-5.
  10. Hu JW, Dostrovsky JO, Sessle BJ. Functional properties of neurons in cat trigeminal subnucleus caudalis (medullary dorsal horn). I. Responses to oral-facial noxious and nonnoxious stimuli and projections to thalamus and subnucleus oralis. J Neurophysiol 1981; 45(2): 173-92.
  11. Ikoma A, Rukwied R, Stander S, Steinhoff M, Miyachi Y, Schmelz M. Neurophysiology of pruritus: interaction of itch and pain. Arch Dermatol 2003; 139(11): 1475-8.
  12. George RB, Allen TK, Habib AS. Serotonin receptor antagonists for the prevention and treatment of pruritus, nausea, and vomiting in women undergoing cesarean delivery with intrathecal morphine: A systematic review and meta-analysis. Anesth Analg 2009; 109(1): 174-82.
  13. Borgeat A, Wilder-Smith OH, Saiah M, Rifat K. Subhypnotic doses of propofol relieve pruritus induced by epidural and intrathecal morphine. Anesthesiology 1992; 76(4): 510-2.
  14. Sane S, Mahoori A, Valizad Hasanloei M A, Karami N, Poormohammad R. Efficacy of intravenous ondansetron on pruritus after intrathecal opioid in cesarean section with spinal anesthesia. J Urmia Univ Med Sci 2016; 27(2): 148-54. [In Persian].
  15. Grant S, Aitchison T, Henderson E, Christie J, Zare S, McMurray J, et al. A comparison of the reproducibility and the sensitivity to change of visual analogue scales, Borg scales, and Likert scales in normal subjects during submaximal exercise. Chest 1999; 116(5): 1208-17.
  16. Kostopanagiotou G, Pandazi A, Matiatou S, Kontogiannopoulou S, Matsota P, Niokou D, et al. The impact of intraoperative propofol administration in the prevention of postoperative pruritus induced by epidural morphine. Eur J Anaesthesiol 2006; 23(5): 418-21.
  17. Hirabayashi M, Imamachi N, Sakakihara M, Saito Y. Treatment of intrathecal fentanyl-induced itch with pentazocine: A case report. Masui 2014; 63(6): 696-9. [In Japanese].
Journal of Isfahan Medical School
Volume 36, Issue 490 - Serial Number 490
July and August 2018
Pages 890-896

  • Receive Date 21 April 2018
  • Accept Date 06 April 2022