Epidural Nalbuphine for Post Cesarean Epidural Morphine Induced Pruritus†
Orawan Pongraweewan MD*, Ubolrat Santawata MD*, Lertluk Weerasarn MD**, Soodsiam Manuwong MD***, Oranee Swasti-xuto MS*
Affiliation : † This manuscript was presented as a poster presentation in the 14th World Congress of Anesthesiologist in Cape Town, South Africa on 2-7 March 2008 * Department of Anesthesiology, Faculty of Medicine,Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Bangkok Hospital, Bangkok, Thailand *** Department of Anesthesiology, Faculty of Medicine, Thammasat University Hospital, Bangkok, Thailand
Objective : The aim of the present study was to test the efficacy of epidural nalbuphine 5 mg for prevention of
morphine-induced pruritus.
Material and Method: Parturients, ASA I-II scheduled for elective cesarean section under epidural anesthesia
were randomized into 3 groups: the placebo group, N-5 group, and N-10 group received 4 ml epidural
solution containing morphine 4 mg plus either saline, nalbuphine 5 mg, and nalbuphine 10 mg respectively.
Pain score at rest and on movement, incidence and severity of pruritus, sedation score, and pethidine
consumption were recorded for 24 hours.
Results : The 182 parturients were randomized into 60 in the placebo group, 61 in the N-5 group, and 61 in the
N-10 group. The severity of pruritus was significantly lower at 3, 6, 9 and 12 h postpartum in the N-5 group
and the N-10 group had a lower degree of pruritus at 3 and 6 h postpartum compared to placebo. The VAS pain
scores at rest and on movement were significantly higher in the N-10 group at 3, 6, 9, 12 and 18 h postpartum
compared to the placebo and significantly higher at 3 h, 6 h postpartum compared to the N-5 group (p < 0.05).
Patient’s satisfactions were high in all groups without any significant difference between groups.
Conclusion : Epidural nalbuphine 5 mg reduced severity of morphine induced pruritus for 12 h with statistically
significant different advantages over epidural nalbuphine 10 mg without anti-analgesic effect. However, the
difference is too small to convey into clinical significant advantage.
Keywords : Adverse effects, Analgesia, Epidural, Cesarean section, Morphine, Nalbuphine, Pruritus
