Nalbuphine vs. chlorpheniramine in reducing intrathecal opioid-induced pruritus in parturients undergoing lower-segment caesarean section
Salimi MOHD SALLEH 1, Esa KAMARUZAMAN 2, Jaafar MD ZAIN 2, Khairulamir ZAINUDDIN 2, Norsidah ABD MANAP 2, Nurlia YAHYA 2
1 Department of Anaesthesiology and Intensive Care, Hospital Kuala Lumpur, Malaysia, 2 Department of Anaesthesiology and Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Malaysia
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.
Keywords: Anaesthesia, anti-histamine, intrathecal opioids, pregnancy, pruritus
Correspondence author: Esa KAMARUZAMAN, Department of Anaesthesiology & Intensive Care, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia.
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Brunei Int Med J. 2012; 8 (3): 128-134