بروز خارش پس از تجویز فنتانیل درون نخاعی: یک مطالعه مقطعی
مجله انجمن آنستزیولوژی و مراقبتهای ویژه ایران,
دوره 2 شماره 120 (1401),
9 شهریور 2024
چکیده
هدف: خارش یکی از عوارض جانبی اصلی تزریق داخل نخاعی مخدرها می باشد. در مطالعه حاضر، شیوع خارش متعاقب تزریق فنتانیل داخل نخاعی و عوامل مرتبط با آن در بیماران بزرگسال ایرانی کاندید عمل جراحی اندام تحتانی بررسی شده است. مواد و روش ها: این مطالعه بر روی 320 بیمار کاندید جراحی اندام تحتانی تحت بیحسی نخاعی انجام شده است . بی حسی نخاعی در شرایط استریل و با ترکیبی از بوپیواکائین و فنتانیل انجام شد. پس از تایید و تثبیت سطح بیحسی، به بیماران 2-1 میلی گرم میدازولام وریدی داده شد. سپس یک پرستار بیهوش پرسشنامه مربوطه را تکمیل می نماید. نتایج: خارش در 84 بیمار (27%) با میانگین نمره شدت 4.94 گزارش شد. از 84 بیمار که خارش را گزارش کردند، 70 نفر نیاز به درمان داشتند. شدت خارش در مردان به طور معنی داری بیشتر از زنان بود (029/0=P). هیچ یک از شاخص های شدت و شیوع خارش با BMI بیماران ارتباط معنی داری نداشت (05/0P>). میانگین سنی بیمارانی که در آنها خارش گزارش شده بود به طور معنی داری کمتر از سن سایر بیماران بود (044/0=P). نتیجه گیری: نتایج ما نشان داد که شدت خارش در مردان به طور قابل توجهی بیشتر است. علاوه بر این، بروز خارش در بیماران جوانتر نیز بیشتر بود.- اوپیوئید درون نخاعی؛ اوپیوئید، خارش؛ فنتانیل
ارجاع به مقاله
مراجع
- Hindle A. Intrathecal opioids in the management of acute postoperative pain. Continuing Education in Anaesthesia, Critical Care & Pain. 2008 Jun 1;8(3):81-5.
- Han SR, Lee CS, Bae JH, Lee HJ, Yoon MR, Lee YS, Al-Sawat A, Shim JW, Hong SH, Lee IK. The additional analgesic effects of transverse abdominis plane block in patients receiving low-dose intrathecal morphine for minimally invasive colorectal surgery: a randomized, single-blinded study. Annals of Surgical Treatment and Research. 2021 Oct 1;101(4):221-30.
- Vitola E, Buraka N, Erts R, Golubovska I, Miscuks A. Effect of different low doses of intrathecal morphine (0.1 and 0.2 mg) on pain and vital functions in patients undergoing total hip arthroplasty: a randomised controlled study. BMC anesthesiology. 2022 Dec;22(1):1-9.
- Al-Sawat A, Lee CS, Hong SH, Shim JW, Chae MS, Han SR, Bae JH, Lee IK, Lee D, Lee YS. Clinical effect of rectus sheath block compared to intrathecal morphine injection for minimally invasive colorectal cancer surgery: a propensity score–matched study. International Journal of Colorectal Disease. 2022 Mar;37(3):665-72.
- Sindt JE, Odell DW, Tariq R, Presson AP, Zhang C, Brogan SE. Initial intrathecal dose titration and predictors of early dose escalation in patients with cancer using a 100: 1 oral to intrathecal morphine conversion ratio. Neuromodulation: Technology at the Neural Interface. 2021 Oct;24(7):1157-66.
- Harris HM, Gul W, ElSohly MA, Sufka KJ. Effects of Cannabidiol and a Novel Cannabidiol Analog against Tactile Allodynia in a Murine Model of Cisplatin-Induced Neuropathy: Enhanced Effects of Sub-Analgesic Doses of Morphine. Medical Cannabis and Cannabinoids. 2018 Jun 12;1(1):54-9.
- Li Y, Hong RA, Robbins CB, Gibbons KM, Holman AE, Caird MS, Farley FA, Abbott MD, Burke MC. Intrathecal morphine and oral analgesics provide safe and effective pain control after posterior spinal fusion for adolescent idiopathic scoliosis. Spine. 2018 Jan 15;43(2):E98-104.
- Gehling M, Tryba M. Risks and side‐effects of intrathecal morphine combined with spinal anaesthesia: a meta‐analysis. Anaesthesia. 2009 Jun;64(6):643-51.
- Abdallah FW, Halpern SH, Margarido CB. Transversus abdominis plane block for postoperative analgesia after Caesarean delivery performed under spinal anaesthesia? A systematic review and meta-analysis. British journal of anaesthesia. 2012 Nov 1;109(5):679-87.
- Bujedo BM, Santos SG, Azpiazu AU. A review of epidural and intrathecal opioids used in the management of postoperative pain. J Opioid Manag. 2012 May 1;8(3):177-92.
- Шарипова ВХ, Сиябаев ФХ, Валиханов АА. THE ROLE OF REGIONAL ANALGESIA METHODS IN KIDNEY TRANSPLANT RECIPIENT PATIENTS. Вестник экстренной медицины. 2023;16(1):55-61.
- Zangouei A, Zahraei SA, Sabertanha A, Nademi A, Golafshan Z, Zangoue M. Effect of low-dose intravenous ketamine on prevention of headache after spinal anesthesia in patients undergoing elective cesarean section: A double-blind clinical trial study. Anesthesiology and pain medicine. 2019 Dec;9(6).
- Lee H, Ko MC. Distinct functions of opioid-related peptides and gastrin-releasing peptide in regulating itch and pain in the spinal cord of primates. Scientific reports. 2015 Jun 29;5(1):11676.
- Ballantyne JC, Loach AB, Carr DB. Itching after epidural and spinal opiates. Pain. 1988 May 1;33(2):149-60.
- Hamber EA, Viscomi CM. Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia. Regional anesthesia and pain medicine. 1999 May 1;24(3):255-63.
- Sawi W, Choy YC. A comparative study of post operative analgesia, side effects profile and patient satisfaction using intrathecal fentanyl with and without morphine 0.1 mg in caesarean section. Middle East J Anaesthesiol. 2013 Feb 1;22(1):21-6.
- Yesuf KA, Gebremedhn EG, Melkie TB. Analgesic effect of intrathecal fentanyl as an adjuvant to spinal anaesthesia in comparison with spinal anaesthesia with bupivacaine only for mothers delivered by emergency cesarean section. J Anesth Crit Care Open Access. 2017;7(5):00278.
- Prin M, Guglielminotti J, Moitra V, Li G. Prophylactic ondansetron for the prevention of intrathecal fentanyl-or sufentanil-mediated pruritus: a meta-analysis of randomized trials. Anesthesia & Analgesia. 2016 Feb 1;122(2):402-9.
- Palmer CM, Cork RC, Hays R, Van Maren G, Alves D. The dose-response relation of intrathecal fentanyl for labor analgesia. The Journal of the American Society of Anesthesiologists. 1998 Feb 1;88(2):355-61.
- Asokumar B, Newman LM, McCarthy RJ, Ivankovich AD, Tuman KJ. Intrathecal bupivacaine reduces pruritus and prolongs duration of fentanyl analgesia during labor: a prospective, randomized controlled trial. Anesthesia & Analgesia. 1998 Dec 1;87(6):1309-15.
- Lopes GS, Bielinski S, Moyer AM, Jacobson DJ, Wang L, Jiang R, Larson NB, Miller VM, Zhu Y, Cavanaugh DC, St Sauver J. Sex differences in type and occurrence of adverse reactions to opioid analgesics: a retrospective cohort study. BMJ open. 2021 Jun 1;11(6):e044157.
- Kornick CA, Santiago-Palma J, Moryl N, Payne R, Obbens EA. Benefit-risk assessment of transdermal fentanyl for the treatment of chronic pain. Drug Safety. 2003 Nov;26:951-73.
- Reich A, Szepietowski JC. Opioid‐induced pruritus: an update. Clinical and experimental dermatology. 2010 Jan 1;35(1):2-6.
- Shen Z, Li W, Chang W, Yue N, Yu J. Sex differences in chronic pain-induced mental disorders: Mechanisms of cerebral circuitry. Frontiers in Molecular Neuroscience. 2023 Feb 20;16:1102808.
- Fang S, Qin Y, Yang S, Zhang H, Zheng J, Wen S, Li W, Liang Z, Zhang X, Li B, Huang L. Differences in the neural basis and transcriptomic patterns in acute and persistent pain-related anxiety-like behaviors. Frontiers in Molecular Neuroscience. 2023 May 26;16:1185243.
- Morgan MM, Ataras K. Sex differences in the impact of pain, morphine administration and morphine withdrawal on quality of life in rats. Pharmacology Biochemistry and Behavior. 2022 Sep 1;219:173451.
- Youssef N, Orlov D, Alie T, Chong M, Cheng J, Thabane L, Paul J. What epidural opioid results in the best analgesia outcomes and fewest side effects after surgery?: a meta-analysis of randomized controlled trials. Anesthesia & Analgesia. 2014 Oct 1;119(4):965-77.
- Pöpping DM, Elia N, Marret E, Wenk M, Tramer MR, Warner DS, Warner MA. Clonidine as an adjuvant to local anesthetics for peripheral nerve and plexus blocks: a meta-analysis of randomized trials. The Journal of the American Society of Anesthesiologists. 2009 Aug 1;111(2):406-15.
- Szarvas S, Harmon D, Murphy D. Neuraxial opioid-induced pruritus: a review. Journal of clinical anesthesia. 2003 May 1;15(3):234-9.
- Bromage PR, Camporesi EM, Durant PA, Nielsen CH. Rostral spread of epidural morphine. Anesthesiology. 1982 Jun;56(6):431-6.
- Sultan P, Gutierrez MC, Carvalho B. Neuraxial morphine and respiratory depression: finding the right balance. Drugs. 2011 Oct;71:1807-19.
- Waxler B, Dadabhoy ZP, Stojiljkovic L, Rabito SF, Warltier DC. Primer of postoperative pruritus for anesthesiologists. The Journal of the American Society of Anesthesiologists. 2005 Jul 1;103(1):168-78.
- Ballantyne JC, Loach AB, Carr DB. Itching after epidural and spinal opiates. Pain. 1988 May 1;33(2):149-60.
- Scott PV, Fischer HB. Spinal opiate analgesia and facial pruritus: a neural theory. Postgraduate Medical Journal. 1982 Sep;58(683):531-5.
- Jennett S. Churchill Livingstone's Dictionary of Sport and Exercise Science and Medicine E-Book. Elsevier Health Sciences; 2008 Apr 1.
- چکیده مشاهده شده: 178 بار