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題名 | Efficacy of Intramuscular Nalbuphine versus Diphenhydramine for the Prevention of Epidural Morphine-induced Pruritus after Cesarean Delivery=比較預防性肌肉注射Nalbuphine和Diphenhydramine對剖腹生產術後硬膜外嗎啡止痛引起之皮膚搔癢的效果 |
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作者姓名(中文) | 廖家志; 張捷思; 曾紀浩; 沈振庭; 蔡時彰; 詹耀龍; 黃樹欽; | 書刊名 | 長庚醫誌 |
卷期 | 34:2 2011.03-04[民100.03-04] |
頁次 | 頁172-178 |
分類號 | 418.25 |
關鍵詞 | 硬膜外嗎啡; 芯奔; 鹽酸二苯胺明; 皮膚搔癢; Epidural morphine; Nalbuphine; Diphenhydramine; Pruritus; |
語文 | 英文(English) |
英文摘要 | Background: Pruritus is the most common side effect of epidural morphine analgesia. Diphenhydramine is a widely used agent for the treatment of urticarial pruritus. Nalbuphine is a mixed opioid agonist–antagonist and has been reported to be effective in treating opioid-induced pruritus. We compared the effectiveness of intramuscular diphenhydramine and nalbuphine for the prevention of epidural morphine-induced pruritus after cesarean section. Methods: One hundred and fifty, American Society of Anesthesiologists physical status I or II, women undergoing cesarean section with epidural anesthesia were randomly assigned to three groups. Group S, group D, and group N received intramuscular normal saline (1 ml; n = 50), diphenhydramine (30 mg/1 ml; n = 50), and nalbuphine (10 mg/1 ml; n = 50), respectively, after delivery of the baby. The occurrence and the severity of pruritus were assessed at 1, 4, 12, and 24 hours after surgery. Results: The overall incidence of pruritus during the 24 hr follow-up period was 72%, 68%, and 44% for group S, group D, and group N, respectively. Pruritus occurred less frequently in group N than group D (p = 0.027). At 4 and 12 hrs postoperatively, the pruritus severity was significantly different (p = 0.003 and p = 0.002) and was significantly less in group N than group D in the intergroup comparison (p = 0.013 and p = 0.012). Conclusion: Nalbuphine proved better than diphenhydramine for prevention of epidural morphine-induced pruritus in patients who underwent cesarean section. Prophylactic intramuscular nalbuphine (10 mg) is effective in decreasing the incidence and severity of pruritus and does not affect analgesia. |
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