Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul-Sep;40(3):381-387.
doi: 10.4103/joacp.joacp_14_23. Epub 2024 Jan 25.

The effect of addition of ultra-low dose of naloxone to fentanyl-bupivacaine mixture on the incidence of pruritis after spinal anesthesia for cesarean delivery: Randomized clinical study

Sameh A Ahmed  1 , Asmaa F Amer  1 , Hashem A Lotfy  2 , Radwa F Mansour  1
Affiliations

The effect of addition of ultra-low dose of naloxone to fentanyl-bupivacaine mixture on the incidence of pruritis after spinal anesthesia for cesarean delivery: Randomized clinical study

Sameh A Ahmed et al. J Anaesthesiol Clin Pharmacol. 2024 Jul-Sep.

Abstract

Background and aims: The use of intrathecal opioids is associated with high risk of pruritis and this may be decreased by adding a low dose of naloxone. This study evaluated the effect of the addition of 20 μg of naloxone to fentanyl-bupivacaine mixture on the incidence of pruritis in pregnant females scheduled for cesarean section (CS).

Material and methods: Eighty pregnant patients scheduled for CS under spinal anesthesia were randomized to receive either 10 mg of 0.5% hyperbaric bupivacaine (2 ml) plus 25 μg fentanyl (group F) or 10 mg of 0.5% hyperbaric bupivacaine (2 ml) plus 25 μg fentanyl and 20 μg naloxone (group FN). The incidence, onset, duration, site, and severity of pruritis were measured. Furthermore, the postoperative numerical rating scale (NRS) score, the total tramadol rescue analgesia, and the time for the first request of rescue analgesia were recorded.

Results: Compared to the F group, the FN group showed a significant decrease in the incidence of pruritis (P = 0.022), prolongation of the onset of pruritis (P = 0.006), shortening of the duration of pruritis (P = 0.029), and decrease in the severity of pruritis (P = 0.039). Furthermore, the postoperative pain score, the rescue analgesic consumption, and the time for the first request of rescue analgesia were comparable between the two groups (P > 0.05).

Conclusions: The addition of an ultra-low dose of naloxone (20 μg) to fentanyl-bupivacaine mixture in spinal anesthesia for pregnant females scheduled for CS significantly reduced the incidence of pruritis without having a significant effect on the postoperative analgesia.

Keywords: Cesarean section; fentanyl; intrathecal; naloxone; pruritis.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
CONSORT flow chart of the study
Figure 2
Figure 2
Maternal satisfaction in the studied groups. Group F (spinal anesthesia with fentanyl–bupivacaine: 38 patients), group FN (spinal anesthesia with fentanyl–naloxone–bupivacaine: 39 patients). Data are presented as the number of patients
See this image and copyright information in PMC

References

    1. Tadevosyan M, Ghazaryan A, Harutyunyan A, Petrosyan V, Atherly A, Hekimian K. Factors contributing to rapidly increasing rates of cesarean section in Armenia: A partially mixed concurrent quantitative-qualitative equal status study. BMC Pregnancy Childbirth. 2019;19:1–10. - PMC - PubMed
    1. Reynolds F, Seed P. Anaesthesia for caesarean section and neonatal acid-base status: A meta-analysis. Anaesthesia. 2005;60:636–53. - PubMed
    1. Kinsella S, Carvalho B, Dyer R, Fernando R, McDonnell N, Mercier F, et al. International consensus statement on the management of hypotension with vasopressors during cesarean section under spinal anesthesia. Anaesthesia. 2018;73:71–2. - PubMed
    1. Bujedo BM, Santos SG, Azpiazu AU. A review of epidural and intrathecal opioids used in the management of postoperative pain. J Opioid Manag. 2012;8:177–92. - PubMed
    1. Szarvas S, Harmon D, Murphy D. Neuraxial opioid-induced pruritus: A review. J Clin Anesth. 2003;15:234–9. - PubMed

LinkOut - more resources