Treatment of epidural morphine‐induced pruritus with buprenorphine

Keaveny, J.; Harper, N.J.N.

doi:10.1111/j.1365-2044.1989.tb13600.x

Cited by 9 publications

(3 citation statements)

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“…Droperidol has also been reported to reduce epidural morphine-induced pruritus when administered either by the intravenous [10] or the epidural [11] route, although similarly its mode of action is likely to be due to sedation. It is possible to abolish spinal opioid-induced itch by naloxone, the specific opiate receptor antagonist [12,13] and also by the administration of opioid agonist/antagonist drugs such as nalbuphine [14], buprenorphine [15] and naltrexone [16]. The two patients in our study who received 0.4 mg of naloxone for persistent troublesome itching did not derive any benefit; it is possible that this was too small a dose.…”

Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

“…Whether or not an HDU can alter this is impossible to know and, in any case, some patients are deliberately discharged to permit a more natural terminal stage. However, it would seem that there must be room for improvement in the expected to live group [14,15].Compared to an ICU the costs after initial outlay are likely to be modest [16] but as the demand increases these will rise [4]. The major cost is in nursing provision and it is difficult to match nurse staffing with bed occupancy although the high usage for elective surgery may make this more predictable than ICU staffing.…”

mentioning

confidence: 99%

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The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for Caesarean section

Warwick

Kearns²,

Scott³

1997

Anaesthesia

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SummaryAll admissions into a six-bedded intensive care unit were audited prospectively over a 2-month period. Data were collected daily and classified according to criteria for intensive care or highdependency admission. There were 30 planned admissions (72 bed days) following elective major surgery, seven admissions following semi-elective surgery (41 bed days) and 47 emergency admissions (185 bed days). Overall bed occupancy was 89%. Of 366 possible intensive care days, 66 (23%) were occupied by high-dependency patients. Of the planned admissions all but five were discharged within 2 days. There were 39 major complications during the study period requiring life-saving interventions and 16 lesser but significant complications. In 12% of patients discharge was delayed because of the absence of a high-dependency unit. Four patients were transferred to an intensive care unit in another hospital and four patients were discharged prematurely because other patients required urgent admission. Seven patients were refused admission and three patients scheduled for elective operations had their surgery deferred. We estimate that over the study period 22 additional patients could have been cared for if a high-dependency unit existed. The suggestion that high-dependency units will solve some of the shortages created by lack of intensive care beds [1][2][3] is unproven. It appears that high-dependency provision significantly reduces the rate of cancellation of major elective surgery [4] and one report suggests a 13% reduction in mortality in the year following its introduction [5]. A high-dependency unit also provides a useful intermediate facility where more complex therapy and monitoring can be provided safely and efficiently [6]. KeywordsWe audited all admissions to our general intensive care unit prospectively over a 2-month period to estimate demand for high-dependency care. MethodThe type of patient (intensive care or high dependency) was recorded daily according to the criteria for admission described by (Appendix). Every patient occupying an intensive care unit (ICU) bed was evaluated at 10 a.m. each day over a 2-month period and classified as requiring an ICU or high-dependency unit (HDU) bed. Although the unit has six beds it was possible to admit more patients than there were beds due to transfers or deaths in the preceding 24-h period. The data collected daily included the patient's name, age, sex, diagnosis, operation (where relevant), complications in the last 24 h, length of stay and ICU outcome. Hospital outcome was determined after completion of the study. We also collected details on the number of ICU transfers in and out of the unit, elective surgical cancellations, refusals for admission to ICU and requests for admission to HDU. FacilitiesThe hospital has a six-bed general ICU which forms the basis for this study. There is also a three-bed liver HDU, a six-bed thoracic HDU, a nine-bed cardiac adult ICU and a six-bed cardiac HDU; these units are not under our direct ResultsThere were 84 admissions in th...

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