Hirabayashi Masato, Doi Katsushi, Imamachi Noritaka, Kishimoto Tomomune, Saito Yoji
From the *Department of Anesthesiology, Hamada Medical Center, Hamada, Shimane, Japan; and †Department of Anesthesiology, Shimane University School of Medicine, Izumo, Japan.
Anesth Analg. 2017 Jun;124(6):1930-1934. doi: 10.1213/ANE.0000000000002060.
The incidence of pruritus after cesarean delivery under spinal anesthesia with opioids is high, ranging from 50% to 100%. Pruritus is difficult to prevent; however, pentazocine has been shown to be an effective treatment. Despite this, the prophylactic effect of pentazocine on pruritus has not been defined. This randomized double-blind trial aimed to evaluate the effect of intraoperative IV pentazocine on the incidence of opioid-induced pruritus within the first 24 hours after administration of neuraxial opioids.
We obtained institutional review board approval and written informed consent from the 122 patients (American Society of Anesthesiologists [ASA] physical status II; aged 20-40 years) scheduled for elective cesarean delivery who were included in this study. Spinal anesthesia was performed with 10 mg of 0.5% hyperbaric bupivacaine, 10 μg of fentanyl, and 100 μg of morphine. After delivery of the baby and placenta, the parturient women were randomized to intravenously receive 15 mg (1 mL) of pentazocine or 1 mL of saline. All women received postoperative analgesia with the epidural infusion of 0.15% levobupivacaine. The presence of pruritus within the first 24 hours after intrathecal administration of opioids was recorded, and severity of itch, numerical rating scale (NRS) for pain, and adverse effects were also recorded at the time of the arrival on the ward, as well as 3, 6, 12, and 24 hours after the intrathecal administration of opioids.
A total of 119 women completed the study. IV pentazocine reduced the overall incidence of pruritus within the first 24 hours compared to IV saline, with an estimated relative risk of 69% (95% confidence interval [CI], 52%, 90%; P = .007). IV pentazocine also reduced the severity of pruritus. The incidence of nausea and vomiting was not significantly different. There were no significant differences in postoperative NRS scores.
A single 15-mg dose of IV pentazocine after delivery can reduce both the incidence and severity of pruritus in women who have received subarachnoid opioids during cesarean delivery.
在蛛网膜下腔麻醉下剖宫产术中使用阿片类药物后瘙痒的发生率很高，范围在50%至100%之间。瘙痒难以预防；然而，喷他佐辛已被证明是一种有效的治疗方法。尽管如此，喷他佐辛对瘙痒的预防作用尚未明确。这项随机双盲试验旨在评估术中静脉注射喷他佐辛对鞘内注射阿片类药物后24小时内阿片类药物引起的瘙痒发生率的影响。
我们获得了机构审查委员会的批准，并获得了本研究中纳入的122例计划进行择期剖宫产的患者（美国麻醉医师协会[ASA]身体状况II级；年龄20 - 40岁）的书面知情同意。采用10 mg的0.5%重比重布比卡因、10 μg芬太尼和100 μg吗啡进行蛛网膜下腔麻醉。胎儿和胎盘娩出后，将产妇随机分为静脉注射15 mg（1 mL）喷他佐辛组或1 mL生理盐水组。所有女性均通过硬膜外输注0.15%左旋布比卡因进行术后镇痛。记录鞘内注射阿片类药物后24小时内瘙痒的发生情况，并在入住病房时以及鞘内注射阿片类药物后3、6、12和24小时记录瘙痒的严重程度、疼痛数字评分量表（NRS）以及不良反应。
共有119名女性完成了研究。与静脉注射生理盐水相比，静脉注射喷他佐辛降低了24小时内瘙痒的总体发生率，估计相对风险为69%（95%置信区间[CI]，52%，90%；P = 0.007）。静脉注射喷他佐辛还降低了瘙痒的严重程度。恶心和呕吐的发生率没有显著差异。术后NRS评分没有显著差异。
产后单次静脉注射15 mg喷他佐辛可降低剖宫产术中接受蛛网膜下腔阿片类药物的女性瘙痒的发生率和严重程度。
