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Canadian Journal of Anesthesia 48:831-832 (2001)
© Canadian Anesthesiologists' Society, 2001

Correspondence

IV butorphanol reduces analgesia but not pruritus or nausea associated with intrathecal morphine

Tetsuya Sakai, MD, Taku Fukano, MD and Koji Sumikawa, MD

Nagasaki, Japan

To the Editor:

Intrathecal morphine provides excellent postoperative analgesia, but it is often accompanied by troublesome adverse effects, i.e., pruritus and nausea.1,2 Some investigators have reported that epidural butorphanol in combination with epidural morphine effectively reduces adverse effects without reversing analgesia.3–5 We tested the hypothesis that prophylactic iv butorphanol might reduce pruritus and nausea associated with intrathecal morphine.

In this randomized prospective double-blind pilot study, 20 patients undergoing total abdominal hysterectomy received spinal anesthesia with tetracaine 15 mg, and morphine 0.15 mg. Fifteen minutes after the administration of spinal anesthesia the patients received saline 1 mL iv, (Group A) or butorphanol 2 mg iv, (Group B). The intensity of pain, pruritus and nausea at three, five, seven and 24 hr after spinal anesthesia, the time of first request for additional analgesics (duration of analgesia), and the consumption of antipruritics and antiemetics were assessed.

The intensities of pain, pruritus and nausea are shown in the TableGo. The intensity of pain at three, five, and seven hours after spinal anesthesia in group B was significantly higher than that in group A. The duration of analgesia in group B (1126 ± 80 min) was significantly shorter than that in group A (1499 ± 159 min). There was no significant difference in the intensity of either pruritus or nausea or in consumption of antipruritic or antiemetic drugs between the groups.


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  		TABLE Intensity of pain, pruritus and nausea (100 mm visual analogue scale score)
 
Based on these preliminary results, we conclude that prophylactic iv butorphanol reduces analgesia but not pruritus or nausea associated with intrathecal morphine.

References

1 Abboud TK, Dror A, Mosaad P, et al. Mini-dose intrathecal morphine for the relief of post-cesarean section pain: safety, efficacy, and ventilatory responses to carbon dioxide. Anesth Analg 1988; 67: 137–43.[Abstract/Free Full Text]

2 Abouleish E, Rawal N, Rashad MN. The addition of 0.2 mg subarachnoid morphine to hyperbaric bupivacaine for cesarean delivery: a prospective study of 856 cases. Reg Anesth 1991; 16: 137–40.[Medline]

3 Lawhorn CD, McNitt JD, Fibuch EE, Joyce JT, Leadley RJ Jr. Epidural morphine with butorphanol for postoperative analgesia after cesarean delivery. Anesth Analg 1991; 72: 53–7.[Abstract/Free Full Text]

4 Lawhorn CD, Brown RE Jr. Epidural morphine with butorphanol in pediatric patients. J Clin Anesth 1994; 6: 91–4.[Medline]

5 Wittels B, Glosten B, Faure EA, et al. Opioid antagonist adjuncts to epidural morphine for postcesarean analgesia: material outcomes. Anesth Analg 1993; 77: 925–32.[Abstract/Free Full Text]




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