Abstract
Purpose
To determine whether epidural naloxone preserved analgesia while minimizing side effects caused by epidural morphine.
Methods
Eighty patients undergoing combined epidural and general anesthesia for hysterectomy were randomly assigned to one of four groups. All received 2 mg epidural morphine bolus one hour before the end of surgery and a continuous epidural infusion was started containing 4 mg morphine in 100 ml bupivacaine 0.125% with either no naloxone (Group 1, n=20), 0.083 μg·kg−1·hr−1 of naloxone (Group 2, n=20), 0.125 μg·kg−1 ·hr−1 of naloxone (Group 3, n = 20) or 0.167 μg·kg−1·hr−1 of naloxone (Group 4, n=20). Analgesia and side effects were evaluated by blinded observers.
Results
The combination of epidural morphine and bupivacaine provided good analgesia. Eight hours after the end of surgery, the pain score in the group receiving the highest dose of naloxone was lower than in the control group (VAS 1.2 vs 2.0,P < 0.05) but there was less pruritus in the high-dose naloxone group (itching score 1.3vs 1.9,P < 0.05). Pain scores were no different in any of the naloxone groups from the control group. Itching was less in both of the higher dose naloxone groups (P < 0.05 at 8, 16, and 32 hours). The incidence of vomiting in the control group was 40%vs 5% for high dose naloxone group (P < 0.05).
Conclusions
Epidural naloxone reduced morphine-induced side effects in dose-dependent fashion without reversal of the analgesic effect.
Résumé
Objectif
Déterminer si la naloxone épidurale préserve l’analgésie tout en réduisant les effets secondaires de la morphine épidurale.
Méthode
Quatre-vingt patientes devant subir une hystérectomie avec une anesthésie péridurale et générale combinée ont été réparties au hasard en quatre groupes. Toutes ont reçu un bolus de 2 mg de morphine épidurale une heure avant la fin de l’opération et une perfusion épidurale continue a été amorcée avec 4 mg de morphine dans 100 ml de bupivacaïne 0, 125 % sans naloxone (Groupe 1, n = 20), avec 0,083μg·kg−1·h−1 de naloxone (Groupe 2, n = 20), ou 0, l25μg·kg−1·h−1 de naloxone (Groupe 3, n = 20) ou 0,167μg· kg−1·h−1 de naloxone (Groupe 4, n = 20). L’analgésie et les effets secondaires ont été évalués par des observateurs impartiaux.
Résultats
La combinaison de morphine épidurale et de bupivacaïne a fourni une bonne analgésie. Huit heures après la fin de l’intervention chirurgicale, le score de douleur chez les patientes qui ont reçu la plus forte dose de naloxone était plus bas que celui des patientes du groupe témoin (EVA 1,2 vs 2,0,P < 0,05), et il y avait moins de prurit chez les patientes ayant reçu la dose élevée de naloxone (score de 1,3vs 1,9,P< 0,05). Les scores de douleur n’ont pas montré de différence intergroupe. Le prurit était moins marqué chez les patientes des deux groupes qui ont reçu les doses plus élevées de naloxone (P < 0,05 à 8, 16, et 32 heures). L’incidence des vomissements chez les patientes témoins a été de 40 %vs 5 % pour les femmes ayant reçu une forte dose de naloxoneP < 0,05).
Conclusion
L’administration épidurale de naloxone réduit les effets secondaires induits par la morphine d’une façon qui dépend de la dose sans renverser l’effet de l’analgésique.
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This study was financially supported by Department of Anesthesiology, Kangnam Saint Mary’s Hospital, Catholic University Medical College.
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Choi, J.H., Lee, J., Choi et al. Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine. Can J Anesth 47, 33–37 (2000). https://doi.org/10.1007/BF03020728
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DOI: https://doi.org/10.1007/BF03020728