Department of Anesthesiology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Ann Med. 2023;55(2):2304671. doi: 10.1080/07853890.2024.2304671. Epub 2024 Jan 17.
Butorphanol has been used to reduce the incidence and severity of neuraxial morphine-induced pruritus. Palonosetron is a commonly used antiemetic for the prevention of postoperative nausea and vomiting. The aim of our study was to compare the effective dose in 50% of subjects (ED50) of intravenous butorphanol infusion with or without a single intravenous bolus of palonosetron for preventing pruritus induced by epidural administration of morphine.
A total of 120 parturients were randomly assigned to receive an intravenous bolus injection of palonosetron plus continuous infusion of butorphanol (Group P + B) or an intravenous bolus of saline plus continuous infusion of butorphanol (Group B) after epidural administration of morphine. The antipruritic effect was graded as satisfactory (numerical rating scale (NRS) of pruritus ≤3) or unsatisfactory (NRS >3) within 48 h after morphine treatment. The first patient in each group received butorphanol infusion at a rate of 4 µg/kg/h. The infusion dose for each subsequent patient in the corresponding group was increased by 0.2 µg/kg/h after an unsatisfactory response or decreased by 0.2 µg/kg/h after a satisfactory response. The ED50 was calculated for each group and compared using up-down sequential analysis.
The ED50 (mean [95% confidence interval (CI)]) of the dose of intravenous butorphanol infusion for preventing moderate to severe pruritus was lower in Group P + B (3.29 µg/kg/min [3.25-3.34 µg/kg/min]) than in Group B (3.57 µg/kg/min [3.47-3.67 µg/kg/min]) ( < 0.05).
Under the conditions of the present study, a prophylactic use of 0.25 mg palonosetron reduced the ED50 of prophylactic infusion of butorphanol by approximately 8% to achieve a satisfactory antipruritic effect after epidural morphine for post-caesarean analgesia.
布托啡诺已被用于降低鞘内吗啡引起瘙痒的发生率和严重程度。帕洛诺司琼是一种常用于预防术后恶心和呕吐的止吐药。本研究的目的是比较静脉注射布托啡诺输注加或不加单次静脉注射帕洛诺司琼预防硬膜外吗啡给药引起瘙痒的半数有效剂量（ED50）。
120 名产妇被随机分为两组：硬膜外给予吗啡后，一组给予帕洛诺司琼静脉推注加布托啡诺持续输注（P+B 组），另一组给予生理盐水静脉推注加布托啡诺持续输注（B 组）。48 小时内瘙痒评分（数字评分量表（NRS）瘙痒评分≤3 为满意，NRS>3 为不满意）。每组的第一位患者以 4μg/kg/h 的速度输注布托啡诺。如果反应不满意，下一位患者的输注剂量增加 0.2μg/kg/h；如果反应满意，下一位患者的输注剂量减少 0.2μg/kg/h。计算每组的 ED50，并使用上下序贯分析进行比较。
P+B 组（3.29μg/kg/min[3.25-3.34μg/kg/min]）预防中重度瘙痒的静脉布托啡诺输注剂量 ED50 低于 B 组（3.57μg/kg/min[3.47-3.67μg/kg/min]）（<0.05）。
在本研究条件下，预防性使用 0.25mg 帕洛诺司琼可使预防输注布托啡诺的 ED50 降低约 8%，以在剖宫产术后镇痛中硬膜外吗啡后获得满意的止痒效果。
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