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Itching after intrathecal morphine. Incidence and treatment
R Slappendel1, E W Weber, B Benraad
1Sint Maartenskliniek, PO Box 9011, 6500 GM Nijmegen, The Netherlands.
European Journal of Anaesthesiology
|October 26, 2000
Summary
Low doses of intrathecal morphine can still cause itching, a side effect that increases with dosage. Promethazine effectively treats this itching, with naloxone rarely needed for severe cases.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Intrathecal morphine is used for postoperative pain management.
- Itching is a known side effect of intrathecal opioids.
Purpose of the Study:
- To determine if low doses of intrathecal morphine cause itching.
- To evaluate the efficacy of promethazine and naloxone for treating morphine-induced itching.
Main Methods:
- A double-blind study involving 143 patients undergoing hip surgery.
- Patients received bupivacaine with varying doses of intrathecal morphine (0.025-0.2 mg).
- Itching incidence was monitored for 24 hours; treatment with promethazine or naloxone was administered as needed.
Main Results:
- Itching incidence increased with morphine dose: 14.3% (0.025 mg) to 61.7% (0.2 mg).
- Promethazine was effective in treating most cases of itching.
- Naloxone was required in only one patient for intractable itch.
Conclusions:
- Itching is a dose-related side effect of intrathecal morphine within the studied range.
- Low doses of intrathecal morphine can still induce itching.
- Intramuscular promethazine is an effective treatment for intrathecal morphine-induced pruritus.