Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-10T15:24:53.287Z Has data issue: false hasContentIssue false
  • English
  • Français

Antipruritic and antiemetic effect of epidural droperidol: comparative study between single and continuous epidural injection

Published online by Cambridge University Press:  24 January 2006

I. H. Lee  and
I. O. Lee
I. H. Lee
Affiliation:
Sungkyunkwan University School of Medicine, Samsung Cheil Hospital, Department of Anesthesiology, Seoul, South Korea
I. O. Lee
Affiliation:
Korea University College of Medicine, Guro Hospital, Department of Anesthesiology, Seoul, South Korea
Get access

Extract

Summary

Background and objectives: This study was designed to investigate whether single epidural droperidol or continuous epidural droperidol inhibit pruritus and postoperative nausea and vomiting induced by postoperative continuous epidural fentanyl administration, and to identify the optimal method of administering epidural droperidol. Methods: 120 ASA I–II patients undergoing subtotal gastrectomy with general anaesthesia combined with epidural anaesthesia were randomly allocated into three groups: control (no droperidol), single injection (droperidol 2.5 mg) and continuous group (droperidol 2.5 mg 2 day−1). Postoperatively the frequency and severity of pruritus and postoperative nausea and vomiting in all groups were compared during 48 h. Results: The frequency and severity of pruritus was significantly lower in both single injection and continuous groups than control group after epidural fentanyl administration (P < 0.05). The frequency and severity of postoperative nausea and vomiting was significantly lower in single injection group than control group after epidural fentanyl administration (P < 0.05). Conclusion: Epidural continuous droperidol is effective for reducing pruritus, and single epidural droperidol injection is effective for reducing pruritus and postoperative nausea and vomiting induced by postoperative continuous epidural fentanyl analgesia.

Keywords

ANAESTHESIA, EXTRADURALDROPERIDOLFENTANYLADVERSE EFFECTSPOSTOPERATIVE NAUSEA AND VOMITINGPRURITUS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 3 , March 2006 , pp. 213 - 218
Copyright
© 2006 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ballantyne JC, Loach AB, Carr DB. Pruritus after epidural and spinal opioids. Pain 1988; 54: 149–160.Google Scholar
Naji P, Farschtschian M, Wilder-Smith OH, Wilder-Smith CH. Epidural droperidol and morphine for postoperative pain. Anesth Analg 1990; 70: 583–588.Google Scholar
Schmelz M, Schmidt R, Bickel A, Handwerker HO, Torebjork HE. Specific C-receptors for itch in human skin. J Neurosci 1997; 17: 8003–8008.Google Scholar
Andrew D, Craig AD. Spinothalamic lamina I neurons selectively sensitive to histamine: a central neural pathway for itch. Nat Neurosci 2001; 4: 72–77.Google Scholar
Krajnik M, Zylicz Z. Understanding pruritus in systemic disease. J Pain Symptom Manage 2001; 21: 151–168.Google Scholar
Chaney MA. Side-effects of intrathecal and epidural opioids. Can J Anaesth 1995; 42: 891–903.Google Scholar
Thomas DA, Williams GM, Iwata K, Kenshalo DR, Dubner R. The medullary dorsal horn: a site of action of morphine in producing facial scratching in monkeys. Anesthesiology 1993; 79: 548–554.Google Scholar
Szarvas S, Harmon D, Murphy D. Neuraxial opioid-induced pruritus: a review. J Clin Anesth 2003; 15: 234–239.Google Scholar
Kyriakides K, Hussain SK, Hobbs GJ. Management of opioid-induced pruritus: a role for 5-HT3 antagonists? Br J Anaesth 1999; 82: 439–441.Google Scholar
Borgeat A. Stirnemann heart rate: ondansetron is effective to treat spinal or epidural morphine-induced pruritus. Anesthesiology 1999; 90: 432–436.Google Scholar
Reves JG, Glass PSA, Lubarsky DA, McEvoy MD. Intravenous nonopioid anesthetics. In: Miller RD, ed. Miller's Anesthesia, 6th edn. New York, USA: Churchill Livingstone Inc, 2005: 359–362.
Olschewski A, Hempelmann G, Vogel W, Safronov BV. Suppression of potassium conductance by droperidol has influence on excitability of spinal sensory neurons. Anesthesiology 2001; 94: 280–289.Google Scholar
Nakata K, Mammoto T, Kita T et al. Continuous epidural, not intravenous, droperidol inhibits pruritus, nausea, and vomiting during epidural morphine analgesia. J Clin Anesth 2002; 14: 121–125.Google Scholar
Kotake Y, Matsumoto M, Ai K, Morisaki H, Takeda J. Additional droperidol, not butorphanol, augments epidural fentanyl analgesia following anorectal surgery. J Clin Anesth 2000; 12: 9–13.Google Scholar
Scott PV, Fischer HB. Spinal opiate analgesia and facial pruritus: a neural theory. Postgrad Med J 1982; 58: 531–535.Google Scholar
Reves JG, Glass PSA, Lubarsky DA, McEvoy MD. Intravenous nonopioid anesthetics. In: Miller RD, ed. Miller's Anesthesia 6th edn. New York, USA: Churchill Livingstone Inc, 2005; 317–378.
Melnick BM. Extrapyramidal reactions to low-dose droperidol. Anesthesiology 1988; 69: 424–426.Google Scholar
Zugel N, Bruer C, Breitschaft K, Angster R. Effect of thoracic epidural analgesia on the early postoperative phase after interventions on the gastrointestinal tract. Chirurg 2002; 73: 262–268.Google Scholar
Azad SC. Perioperative pain management in patients undergoing thoracic surgery. Curr Opin Anaesthesiol 2001; 14: 87–91.Google Scholar
Tang J, Wang B, White PF et al. The effect of timing of ondansetron administration on its efficacy, cost-effectiveness, and cost–benefit as a prophylactic antiemetic in the ambulatory setting. Anesth Analg 1998; 86: 274–282.Google Scholar
Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 1992; 77: 162–184.Google Scholar
Laurence LB. Agents affecting gastrointestinal water flux and motility; emesis and antiemetics; bile acids and pancreatic enzymes. In: Joel GH, Lee EL, Perry BM, Ruddon RW, Gilman AG, eds. Goodman and Gilman's The Pharmacological Basis of Therapeutics, 9th edn. New York: McGraw-Hill, 1996: 917–936.
Niemi G, Breivik H. Epidural fentanyl markedly improves thoracic epidural analgesia in a low-dose infusion of bupivacaine, adrenaline and fentanyl. A randomized, double-blind crossover study with and without fentanyl. Acta Anaesthesiol Scand 2001; 45: 221–232.Google Scholar
Suzuki A, Osawa S, Kanai A, Ozawa A, Okamoto H, Hoka S. Effectiveness of ropivacaine and fentanyl for postoperative epidural analgesia following thoracic surgery Masui 2005; 54: 2–7.Google Scholar
Yaksh T, Provencher JC, Rathbun ML, Kohn FR. Pharmacokinetics and efficacy of epidurally delivered sustained-release encapsulated morphine in dogs. Anesthesiology 1999; 90: 1402–1412.Google Scholar
Durant PA, Yaksh TL. Distribution in cerebrospinal fluid, blood, and lymph of epidurally injected morphine and inulin in dogs. Anesth Analg 1986; 65: 583–592.Google Scholar
Sabbe MB, Grafe MR, Mjanger E, Tiseo PJ, Hill HF, Yaksh TL. Spinal delivery of sufentanil, alfentanil and morphine in dogs: physiologic and toxicologic investigations. Anesthesiology 1994; 81: 899–920.Google Scholar
Fisher M, Bonnet F, Trang H et al. The pharmacokinetics of droperidol in anesthetized patients. Anesthesiology 1986; 64: 486–489.Google Scholar
Grunwald Z, Torjman M, Schieren H, Bartkowski RR. The pharmacokinetics of droperidol in anesthetized children. Anesth Analg 1993; 76: 1238–1242.Google Scholar
McClellan KJ, Faulds D. Ropivacaine: an update of its use in regional anaesthesia. Drugs 2000; 60: 1065–1093.Google Scholar
Knudsen K, Beckman Suurkula M, Blomberg S et al. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997; 78: 507–514.Google Scholar
Hodgson PS, Liu SS. A comparison of ropivacaine with fentanyl to bupivacaine with fentanyl for postoperative patient-controlled epidural analgesia. Anesth Analg 2001; 92: 1024–1028.Google Scholar