Nalbuphine vs. chlorpheniramine in reducing intrathecal opioid-induced pruritus in parturients undergoing lower-segment caesarean section

Background: Pruritus is a common complication of intrathecal opioids and numerous medications have been used to prevent or treat this complication. However, the efficacy of these medications vary. The choice of medications also depends on the availability and the cost. We performed a randomised double-blind study to evaluate whether nalbuphine is as effective as chlorpheniramine, a medication that is commonly used for treating pruritus for the treatment of intrathecal opioid-induced pruritus in parturients undergoing lower-segment caesarean section. Materials and Methods: Two hundred and thirty four parturients with American Society of Anaesthesiologists (ASA) physical status I or II who had intrathecal opioid-induced pruritus were assigned to receive either intravenous nalbuphine (4 mg eight-hourly) or intravenous chlorpheniramine (5 mg eight-hourly) for a period of 24 hours. Pruritus was assessed using a qualitative scale at pre-treatment, six, nine, 12 and 24 hours post-treatment. Results: The occurrence of intrathecal opioid-induced pruritus was significantly reduced in parturients treated with intravenous nalbuphine as compared to intravenous chlorpheniramine at all intervals studied. Conclusion: In conclusion, nalbuphine is more effective than chlorpheniramine in reducing intrathecal opioid-induced pruritus for parturients undergoing lower-segment caesarean section.

Larygospasm secondary to a multinodular goitre

Laryngospasm is a serious event that can result in partial or complete upper airway obstruction. It is a common complication during recovery phase of anaesthesia, resulting from acute irritation of the vocal folds. We report a rare case of laryngospasm secondary to a multinodular goitre that settled after treatment. We postulate that the enlarged thyroid gland can lead to direct irritation of the laryngeal nerve as possible cause of repeated episodes of laryngospasm in this patient. To our knowledge, this is the first reported case of a multinodular goitre as the underlying cause of laryngospasm.