The effect of the addition of ropivacaine or bupivacaine upon pruritus induced by intrathecal fentanyl in labour

Abstract

Sixty patients in early labour were randomly allocated to one of three groups. The control group received intrathecal fentanyl 25 microg, the ropivacaine group received intrathecal fentanyl 25 microg and ropivacaine 2.5 mg while the bupivacaine group received intrathecal fentanyl 25 microg and bupivacaine 2.5 mg. The incidence of pruritus was 100% in controls, compared with 85% in the ropivacaine group (not significant) and 75% in the bupivacaine group (p = 0.003). The severity of pruritus was significantly less in the ropivacaine (p = 0.006) and bupivacaine (p = 0.001) groups. Most patients developed pruritus by 30 min. Pruritus above the abdomen was not reduced in patients receiving local anaesthetics. There were no significant differences in the mean pain visual analogue score, systolic blood pressure, maternal heart rate and upper level of reduced pin-prick sensation in the first 30 min. Intrathecal ropivacaine and, more so, intrathecal bupivacaine reduce the incidence and severity of pruritus from intrathecal fentanyl for labour analgesia.

Intrathecal fentanyl-induced pruritus during labour: the effect of prophylactic ondansetron

“…However, intrathecal fentanyl is associated with a high incidence of pruritus, the overall incidence of 95% in this study being consistent with previous studies. [2][3][4][5][6] In this study, intravenous ondansetron given before intrathecal fentanyl administration for spinal analgesia during labour did not reduce the incidence or severity of opioid-induced pruritus. Pregnant women appear particularly likely to develop pruritus following neuraxial opioids, possibly related to the interaction of oestrogen with opioid receptors in the spinal cord.…”

“…1 However, the incidence of pruritus after intrathecal fentanyl is particularly high, ranging from 70% to 100%. [2][3][4][5][6] Ondansetron, a 5-hydroxytryptamine type three (5HT 3 ) receptor antagonist, is an effective antiemetic, but has also been used to prevent or treat pruritus in a number of clinical settings. These include pruritus induced by i.v., 7 epidural 8 and intrathecal opioids.…”

Spinal hyperbaric ropivacaine-fentanyl for day-surgery

“…23 Without any local anesthetics, IT fentanyl 25 g seems to cause itching in 100% of patients. 24 In conclusion, hyperbaric ropivacaine 10 mg with fentanyl 20 g provided fast onset, high success, and sufficient duration of analgesia for 1-hour surgery. In most patients, motor block was clearly unilateral, which recovered completely in 1 hour, and the patients were able to walk 2.5 hours after the intrathecal anesthetic injection.…”

Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus and post-operative nausea and vomiting in patients undergoing caesarean section

“…The incidence of PONV in patients who received an intrathecal opiate is 60% - 80% [ 4 ]. The incidence of neuraxial opioid-induced pruritus varies widely from 30% - 60% after orthopedic surgery with intrathecal morphine injection [ 3 , 5 – 7 ] and from 60% - 100% in pregnant women after neuraxial opioid administration [ 3 , 8 – 10 ]. Parturients appear to be the most susceptible to neuraxial opioid-induced pruritus which probably might be due to the interaction of oestrogens with opioid receptors [ 8 , 11 ].…”