Efficacy of Intrathecal Morphine With Epidural Ropivacaine Infusion for Postcesarean Analgesia

Mikuni, Ikuomi; Hirai, Hiroyasu; Toyama, Yoshiyuki; Takahata, Osamu; Iwasaki, Hiroshi

doi:10.1097/01.aoa.0000400341.46140.75

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…The addition of opioids as an adjunct to postcesarean pain treatment improves the quality of the block. In our study, we added fentanyl to the bupivacaine as in the literature [14,29,30]. Moreover, we administered PCEA to our patients because it was found that epidural bolus in conjunction with the PCEA regimen was of greater benefit to the parturient and fetus [7,31].…”

Section: Discussionmentioning

confidence: 99%

Effects of different epidural initiation volumes on postoperative analgesia in cesarean section

et al. 2020

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This study was conducted after obtaining Ethics Committee approval from the İnönü University Medical Faculty (2015/171) and informed consent from all of the Background/aim: The aim of this study was to compare the effects of different epidural initiation volumes on postoperative pain scores, analgesic requirements, and side effects in pregnant women administered patient-controlled epidural analgesia (PCEA) for postoperative pain after cesarean sections.Materials and methods: Eighty-one pregnant women, aged 18-45 years, were included in this randomized, double-blind study. Combined spinal epidural anesthesia was administered for each cesarean section. The patients were divided into 3 groups and different volumes (20 mL, 10 mL, and 5 mL) of the study drug (0.0625% bupivacaine plus 2 μg/mL of fentanyl) were administered 90 min after the spinal block via epidural catheter. The visual analogue scale (VAS) scores at rest and during movement, first PCEA dose time, number of PCEA doses required per hour, total analgesic consumed, and side effects were recorded postoperatively.Results: There were no statistically significant differences among the groups in terms of the VAS rest and VAS movement scores. The times to the first analgesic dose requirement were longer in Group 10 and Group 20 than in Group 5. The analgesic requirement during the first 2 h was lower in Group 20 than in the other groups. Conclusions: The PCEA initiations with different volumes provided similar pain scores. However, the 20 mL volume resulted in a lower analgesic dose requirement during the early postoperative period, and it also delayed the requirement for analgesia.

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Section: Discussionmentioning

confidence: 99%

Effects of different epidural initiation volumes on postoperative analgesia in cesarean section

et al. 2020

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“…Generalized itch sometimes accompanies systemic administration of morphine. 20,21) Although intracutaneous administration of morphine induces mast-cell degranulation and plasma levels of histamine are elevated after intravenous administration of morphine, 22) this effect is not attenuated by naloxone, an MoR antagonist, suggesting that morphine makes histamine released from mast cells independently of the MoR. 23) on the contrary, itch after spinal administration of morphine seems histamine-independent.…”

Section: Peripheral Pruritogensmentioning

confidence: 99%

Updated Neurophysiology of Itch

Ikoma¹

2013

Biological & Pharmaceutical Bulletin

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The unique physiological features of histamine-sensitive C-fibers and spinothalamic tract neurons support the hypothesis of itch specific pathway, whereas subsequent studies on cowhage-induced itch have provided evidence against it, suggesting the presence of multiple neural pathways for itch. Not only peripheral pruritogens but also spinal neural receptors are involved in the control of itch, and will be the target of treatment. Itch sensitization in chronic pruritus is another crucial factor that needs to be considered in the treatment. Neuropathic itch is the type of itch that occurs when nerve fibers are damaged or injured and spontaneous firing of nerves takes place, and plays a major role in itch accompanying some pathological conditions such as herpes zoster. The complexity of itch is due to the broad range of mediators involved and the large variety of neural mechanisms behind.

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“…Morphine is one of the best‐known μ‐opioid receptor (MOR) agonists and has been used as analgesic agent for many centuries. As a cumbersome adverse event, epidural or spinal administration of morphine frequently causes segmental pruritus, whereas generalized itch, although rare, accompanies systemic administration of morphine [3,4]. Accordingly, intracutaneous administration of morphine induces mast‐cell degranulation, and plasma levels of histamine are elevated after morphine is given intravenously [5].…”

Section: Opioid Receptorsmentioning

confidence: 99%

Role of Spinal Neurotransmitter Receptors in Itch: New Insights into Therapies and Drug Development

Cevikbas

Steinhoff

Ikoma

2010

CNS Neuroscience & Therapeutics

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Targets for antipruritic therapies are now expanding from the skin to the central nervous system. Recent studies demonstrate that various neuronal receptors in the spinal cord are involved in pruritus. The spinal opioid receptor is one of the best-known examples. Spinal administration of morphine is frequently accompanied by segmental pruritus. In addition to μ-opioid receptor antagonists, κ-opioid receptor agonists have recently come into usage as novel antipruritic drugs, and are expected to suppress certain subtypes of itch such as hemodialysis- and cholestasis-associated itch that are difficult to treat with antihistamines. The gastrin-releasing peptide receptor in the superficial dorsal horn of the spinal cord has also received recent attention as a novel pathway of itch-selective neural transmission. The NMDA glutamate receptor appears to be another potential target for the treatment of itch, especially in terms of central sensitization. The development of NMDA receptor antagonists with less undesirable side effects on the central nervous system might be beneficial for antipruritic therapies. Drugs suppressing presynaptic glutamate-release such as gabapentin and pregabalin also reportedly inhibit certain subtypes of itch such as brachioradial pruritus. Spinal receptors of other neuromediators such as bradykinin, substance P, serotonin, and histamine may also be potential targets for antipruritic therapies, given that most of these molecules interfere not only with pain, but also with itch transmission or regulation. Thus, the identification of itch-specific receptors and understanding itch-related circuits in the spinal cord may be innovative strategies for the development of novel antipruritic drugs.

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Efficacy of Intrathecal Morphine With Epidural Ropivacaine Infusion for Postcesarean Analgesia

Cited by 4 publications

References 5 publications

Effects of different epidural initiation volumes on postoperative analgesia in cesarean section

Effects of different epidural initiation volumes on postoperative analgesia in cesarean section

Updated Neurophysiology of Itch

Role of Spinal Neurotransmitter Receptors in Itch: New Insights into Therapies and Drug Development

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