Comparison between Nalbuphine and propofol for Treatment of intrathecal morphine-induced pruritus after cesarean section

ABSTRACT

Intrathecal opioids are frequently used in management of postoperative pain, but may be associated with many adverse effects such as pruritus, nausea, vomiting, urinary retention, and respiratory depression, which may limit their use. Our study was done to compare between nalbuphine [a mixed opioid agonist antagonist] and propofol [2-6 di-isopropylphenol] in treating intrathecal morphine-induced pruritus after cesarean delivery. It included one hundred forty one parturients undergoing elective cesarean section with spinal anesthesia and post-operative analgesia by intrathecal morphine [0.3 mg]. Ninty four parturients were reported to have moderate to severe pruritus. Without pre-medications, all women were hydrated with 500 to 1000 ml of normal saline before intrathecal injection of 7.5-10 mg of bupivacaine for spinal anesthesia and morphine 0.3 mg for postoperative pain control. Heart rate, mean blood pressure, respiratory rate and oxygen saturation were monitored. The degree and onset of pruritus were also recorded. Those parturients whose pruritus scores was >/= 3 or those who requested antipruritic treatment were assigned to receive either 3mg nalbuphine IV, 20mg propofol IV or placebo. The degree of success was reported when pruritus score decreased to 1 or 2 after treatment and then women were evaluated every 15 minutes for up to 4 hours to determine the duration of antipruritic response. The patients who continued to have pruritus scores >/= 3 were considered treatment failure after only a single dose of the study medicine. Any side effects from spinal anesthesia or from the drugs used were recorded. we were able to demonstrate that the success rate after treatment with 3 mg of nalbuphine was significantly greater than with 20 mg of propofol. Among the successfully treated patients, [8%] in the Nalbuphine group and [5.3%] in the Propofol group reported the recurrence of moderate to severe pruritus [pruritus score >/= 3] within 4 hours after administration of the study drug. Among all the treated patients, [21.9%] in the Nalbuphine group and [40.6%] in the Propofol group reported failure of success [moderate to severe pruritus [pruritus score >/= 3]] within 15 minutes after administration of the study drug. our study showed that nalbuphine [3 mg] was superior to propofol [20 mg] in the treatment of intrathecal morphine induced pruritus after cesarean delivery