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OBSTETRIC ANESTHESIA

Nalbuphine Versus Propofol for Treatment of Intrathecal Morphine-Induced Pruritus After Cesarean Delivery

Department of Anesthesiology, the Clinical Epidemiology Unit, and the Department of Preventive Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Address correspondence and reprint requests to Charuluxananan Somrat, MD, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Rama IV Rd., Pathumwan, Bangkok 10330, Thailand.

In this prospective, randomized, double-blinded study, we compared the efficacy of nalbuphine and propofol for treating intrathecal morphine-induced pruritus after cesarean delivery. One-hundred-eighty-one parturients who developed moderate to severe pruritus after the administration of intrathecal morphine were randomly allocated into two groups. One group received 3 mg IV nalbuphine (n = 91), and the other received 20 mg IV propofol (n = 90). The improvement of pruritus and other adverse effects was determined at 10 min after study drug administration. The treatment success rate was higher in the Nalbuphine group than in the Propofol group (83% vs 61%; P < 0.001). Among the successfully treated patients, recurrence rates of moderate to severe pruritus within 4 h were not significantly different (nalbuphine 9% versus propofol 7%; P = 0.76). Other side effects, such as decreased analgesia, increased nausea, vomiting, increased sedation, pain on injection, and dizziness, were not significantly different between groups. Sedation and pain on injection, which were the two most common side effects, were minor and clinically inconsequential.

Implications: Nalbuphine was superior to propofol for the treatment of intrathecalmorphine-induced pruritus after cesarean delivery.

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