Hydroxyzine for the prevention of pruritus and nausea vomiting from spinal morphine in patients having transabdominal hysterectomy under combined spinal-general anesthesia: A randomized control trial.

Background: Pruritus and nausea vomiting are common side effects of spinal morphine and general anesthesia. Hydroxyzine is one of the antihistamines that are used for treating pruritic and nauseous patients. A randomized prospective double-blind study was undertaken in order to identify the preventive effects of hydroxyzine to prevent pruritus and nausea vomiting in patients who have transabdominal hysterectomy under combined spinal-general anesthesia. Methods: 80 patients scheduled for elective transabdominal hysterectomy under combined spinal-general anesthesia were randomized to receive either hydroxyzine 75 mg and oral midazolam 7.5 mg (atarax or ATR group) or placebo and oral midazolam 7.5 mg (control or C group) as premedication at least half an hour before their operation. Clinical data (vital signs, pruritic score, nauseous score, sedation score, etcetera) were recorded at pre-operative, intraoperative and 48-hour post-operative periods. All patients had spinal block with 0.5% heavy bupivacaine 2 ml with 0.3 mg preservative free morphine and general anesthesia with thiopenthal sodium 5 mg/kg as induction, intubated with atracurium 0.6 mg/kg and maintenance with nitrous oxide in 50% oxygen and isoflurane. A conventional reversal technique was done in all patients. Intravenous fentanyl was used for pain as needed, oral chropheniramine syrup 2 tsp (4 mg/10 ml) every 4 hours was used for pruritus and intravenous ondanzetron (8 mg) was used for nausea/vomiting in the post-operative period. Results: Pruritus and nausea vomiting were observed blindly 24 and 48 hours post-operation. At 24 hours post-operation, there were 5 patients in the ATR group (12.5%) and 6 patients in the control group (15%) who had mild pruritus. There was no significant difference between the two groups (p = 0.745). At 48 hours post-operation, all patients were free of pruritus. There were 2 patients who had mild nausea (5%) and 2 patients who had moderate nausea (5%) in the control group within 24 hours post-operation. In the ATR group there was no patient who had mild or moderate nausea. There was no significant difference between the two groups (p = 0.152). At 48 hours post-operation, there was 1 patient in each group who had mild nausea (2.5%), which had no significant difference. At 24 and 48 hours post-operation, all patients were free of vomiting. Conclusion: Hydroxyzine cannot prevent pruritus and nausea/vomiting from spinal morphine in patients having transabdominal hysterectomy under combined spinal-general anesthesia.

Primary ovarian tumors in postmenopausal women: A 10-year review.

This retrospective study reports on 403 postmenopausal women with ovarian tumors treated at Siriraj Hospital over a ten-year period from 1988-1997. Of the total, 206 (51.1%) were benign, and 197 (48.9%) were malignant. Common epithelium was the most common type (77.9%) and germ cell was the second most common tumor (13.9%), found in this age group. The risk of malignancy increased with age of the patient (p<0.001). More than half of the cases had advanced disease (stage III or IV). Nulliparity, absominal distension as the presenting symptom and bilaterality were more commonly found in patients with malignant disease than those with benign tumors. However, tumor size between the tow group was not significantly different.