Evaluation of a Non-Food and Drug Administration-Approved Use of Cimetidine: Treatment of Pruritus Resulting from Epidural Morphine Analgesia

Raisch, Dennis W.; Barreuther, Alan; Osborne, Robert Carry

doi:10.1177/106002809102500702

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…Of the remaining 44 reports, 22 were subsequently excluded. In 10, the number of patients who were completely free from pruritus after the administration of the study drugs was not reported [11][12][13][14][15][16][17][18][19][20]. Five had no placebo or 'no treatment' control group [21][22][23][24][25].…”

Section: Retrieved Trialsmentioning

confidence: 99%

Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials

Kjellberg

Tramèr

2001

European Journal of Anaesthesiology

134

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Background and objective Numerous drugs have been used to prevent or to treat opioid-induced pruritus in the surgical setting. Their relative efficacy is not well understood. Methods The methods employed involved the systematic search (MEDLINE, EMBASE, Cochrane library, bibliographies, without language restriction, up to June 2000) for full reports of randomized comparisons of any intervention which is thought to be anti-pruritic (active) compared with placebo or no treatment (control) in surgical (including labour) patients receiving opioids. The number of patients who had no pruritus were analysed using relative risk and number-neededto-treat with 95% confidence interval. Results Twenty-two trials (1477 patients) were analysed. Two trials (66 patients), both with low-dose propofol, were on treatment of established pruritus; propofol had no anti-pruritic effect compared with Intralipid. In prophylaxis trials, the average incidence of pruritus with control was 59% (range, 10% to 100%). Most mu-receptor antagonists were efficacious: intravenous naloxone 0.25-2.4 mg kg À1 h À1 , relative risk 2.31 (95% confidence interval, 1.5 to 3.54), numberneeded-to-treat to prevent pruritus compared with control 3.5; oral naltrexone 9 mg, relative risk 2.80 (1.35-5.80), number-needed-to-treat 1.7; naltrexone 6 mg was less effective and 3 mg did not work; different intravenous and epidural nalbuphine regimens, relative risk 1.71 (1.12-2.62), number-needed-to-treat 4.2. Intravenous nalmefene 0.5 or 1 mg was not antipruritic. Intravenous (but not epidural) droperidol 2.5 mg was efficacious, relative risk, 1.71 (1.28-2.29), number-needed-to-treat 4.9. There was a lack of evidence for any anti-pruritic efficacy with prophylactic propofol, epidural or intrathecal epinephrine, epidural clonidine, epidural prednisone, intravenous ondansetron, or intramuscular hydroxyzine. Conclusion Naloxone, naltrexone, nalbuphine and droperidol are efficacious in the prevention of opioidinduced pruritus; minimal effective doses remain unknown. There is a lack of valid data on the efficacy of interventions for the treatment of established pruritus.

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Section: Retrieved Trialsmentioning

confidence: 99%

Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials

Kjellberg

Tramèr

2001

European Journal of Anaesthesiology

134

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“…Of the remaining 44 reports, 22 were subsequently excluded. In 10, the number of patients who were completely free from pruritus after the administration of the study drugs was not reported [11–20]. Five had no placebo or ‘no treatment’ control group [21–25].…”

Section: Resultsmentioning

confidence: 99%

Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials

2001

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“…Several investigators have tried to reduce opiate adverse effects by giving oral, intravenous, or topical medication such as naltrexone [1], nalbuphine [10,17,32], droperidol [21,24,30], scopolamine [27], or cimetidine [34]. Nahi et al [30] used 4 mg epidural morphine with either placebo or 2,5 mg droperidol in patients undergoing hip replacement surgery.…”

Section: Side Effects Of Epidural Opioidsmentioning

confidence: 99%

“…Some of them are rare, but life-threatening, such as severe respiratory depression [52] or cervical spinal cord infarction [5]. Other complications, e.g., pruritus [24,34,48], urinary retention [1,8,17,30,51], and nausea [20,25,27,53], are more common, but not dangerous.…”

Section: Side Effects Of Epidural Opioidsmentioning

confidence: 99%

Intra-operative epidural morphine, fentanyl, and droperidol for control of pain after spinal surgery A prospective, randomized, placebo-controlled, and double-blind trial

1996

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The present study was conducted to investigate the analgesic effects of intra-operatively administered epidural morphine in patients undergoing surgery for lumbar disc disease. Three treatment groups were constituted: one with 5.0 mg morphine and 2.5 mg dehydrobenzperidol (DHB) in 10 ml physiological saline, one with 5.0 mg morphine and 0.1 mg fentanyl in the same amount of saline, and one placebo group with saline only. The test solution was injected epidurally via catheter after haemostasis and before closure of the wound. Sixty eight patients were randomly assigned to each of the three groups and subjected to a double-blind evaluation. In the morphine/fentanyl and morphine/droperidol groups, significantly better analgesia was found as compared to the placebo group. No significant difference was found between the morphine/fentanyl and morphine/droperidol groups considering side effects of therapy, as well as duration and quality of analgesia. The side effects in the treatment groups were only slight and not significantly different from the placebo group. It was shown that additional epidural fentanyl offers no significant improvement of postoperative analgesia. No significant reduction of adverse effects could be found in the morphine/droperidol group compared to the morphine/fentanyl group. In conclusion, the intra-operative epidural application of morphine is a safe, effective and simple method for achieving sufficient analgesia in the first 24 hours after lumbar spinal surgery for disc disease.

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Evaluation of a Non-Food and Drug Administration-Approved Use of Cimetidine: Treatment of Pruritus Resulting from Epidural Morphine Analgesia

Cited by 5 publications

References 10 publications

Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials

Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials

Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials

Intra-operative epidural morphine, fentanyl, and droperidol for control of pain after spinal surgery A prospective, randomized, placebo-controlled, and double-blind trial

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