The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Prevalence of pruritus following Intrathecal fentanyl and sufentanil after spinal anesthesia in cesarean section

Document Type : Original Article

Authors
Soheil Lord Lasemi 1
Parvin Delavar 2
Shahrzad Hadavand 3
1 Student of Medicine, Faculty of Medicine, Shahed University, Tehran, Iran.
2 Assistant Professor, Department of Anesthesiology and Intensive Care, School of Medicine, Shahed University, Tehran, Iran.
3 Assistant Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Shahed University, Tehran, Iran.
10.22038/ijogi.2021.18301
Abstract
Introduction: Intratechal opioids in combination with local anaesthetic drugs are commonly used for analgesic induction during cesarean section. Lipophilic opioids such as Fentanyl and Sufentanil are among most commonly used intratechal opioids. Pruritus is one of the most common complications of opioids. So, this study was performed with aim to compare the frequency and severity of pruritus following intratechal administration of fentanyl or sufentanil with Bupivacaine in elective cesarean section.
Methods: This double-blind randomized clinical trial study was performed in 2019 on 50 pregnant women candidate for elective cesarean section and referred to Shahid Mostafa Khomeini hospital in Tehran. The subjects were randomly divided into two groups. One group received 25 microgram intratechal fentanyl and another group received 2.5 microgram sufentanil both in combination with 12.5 miligram hyperbaric bupivacaine 0.5%. After the surgery, data about age, BMI, surgery duration and pruritus were evaluated. Data were analysed by SPSS software (version 21) and Chi-square and Independent t-test. P<0.05 was considered statistically significant.
Results: There was no significant difference between the two groups in terms of age (P=0.428), BMI (P=0.339) and surgery duration (P=0.296). Frequency of pruritus was 68% in fentanyl and 88% in sufentanil groups; this difference was not statistically significant (P=0.088). Pruritus severity (P=0.361) and use of anti-pruritus drug (P=0.333) showed no significant difference between the two groups.
Conclusion: Pruritus is a common side-effect of intratechal fentanyl and sufentanil.
There was no evidence in favour of higher prevalence of pruritus in the sufentanil group than the fentanyl group.
Keywords
Cesarean section
Fentanyl
Pruritus
Spinal anesthesia
Sufentanil
  1. Cunningham FG, Kenneth J, Bloom SL, Spong CY, Dash JS, Hoffman BL, et al. Williams obstetrics. 24nd ed. New York: McGraw-Hill; 2014
  2. Hamzei A, Basiri-Moghadam M, Pasban-Noghabi S. Effect of dexamethasone on incidence of headache after spinal anesthesia in cesarean section. A single blind randomized controlled trial. Saudi Med J 2012; 33(9):948-53.
  3. Nooripoor S, Moradan S, Gorbani R, Hemmati AA, Delghandi M. Comparison of the effects of general anesthesia and spinal analgesia on newborns' Apgar score in cesarean section. The Iran J Obstet Gynecol Infertil 2015; 17(135):1-8.
  4. Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally applied morphine in man. Survey of Anesthesiology 1979; 23(6):384.
  5. Nasr IA, Elokda SA. Safety and efficacy of intrathecal adjuvants for cesarean section: bupivacaine, sufentanil, or dexmedetomidine. Ain-Shams Journal of Anaesthesiology 2015; 8(3):388.
  6. Farzi F, Mirmansouri A, Naderi Nabi B, Atrkar Roushan Z, Ghazanfar Tehran S, Nematollahi Sani M, et al. Comparing the Effect of Adding Fentanyl, Sufentanil, and Placebo with Intrathecal Bupivacaine on Duration of Analgesia and Complications of Spinal Anesthesia in Patients Undergoing Cesarean Section. Anesth Pain Med 2017; 7(5):e12738.
  7. Braga Ade F, Braga FS, Hirata ES, Pereira RI, Frias JA, Antunes IF. Association of lipophilic opioids and hyperbaric bupivacaine in spinal anesthesia for elective cesarean section. Randomized controlled study. Acta Cir Bras 2014; 29(11):752-8.
  8. Yahya M, Sriramamurthy K, Farhat S, Kumari S. Effect of addiction of fentanyl to low dose bupivacaine in cesarean under spinal anesthesia. Eur J Pharm Med Res 2017; 4(2):568-72.
  9. Zirak N, Hafizi L, Eftekharzadeh S, Ghomian N, Moradifar M, Golmakani E. Evaluating the effect of regular-dose of bupivacain against its low-dose plus fentanyl in spinal anesthesia of elective cesarean section on term neonatal apgar score and time of sensory-block regression. Iran J Obstet Gynecol Infertil 2012; 15(20):12-18.
  10. LaBella FS, Kim RS, Templeton J. Opiate receptor binding activity of 17-alpha estrogenic steroids. Life Sci 1978; 23(17-18):1797-804.
  11. Stoelting RK, Miller RD: Basics of anesthesia. 5nd ed. London Churchill Livingstone; 2007.
  12. Bujedo BM. An Update on Neuraxial Opioid Induced Pruritus Prevention. J Anesth Crit Care Open Access 2016; 6(2):00226.
  13. Kumar K, Singh SI. Neuraxial opioid-induced pruritus: An update. J Anaesthesiol Clin Pharmacol 2013; 29(3):303-7.
  14. Bujedo BM. Current Update in the Management of Post-operative Neuraxial Opioid-induced Pruritus. Journal of Clinical Research in Anesthesiology 2018; 1(1):1-0.
  15. Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth 1995; 42(10):891-903.
  16. Gropper MA, Cohen NH, Eriksson LI, Fleisher LA, Leslie K, Wiener-Kronish Jp. Miller’s Anesthesia. 9nd ed; 2020.
  17. Reich A, Szepietowski JC. Pruritus intensity assessment: challenge for clinicians. Expert Review of Dermatology 2013; 8(3):291-9.
  18. Braga Ade F, Braga FS, Potério GM, Pereira RI, Reis E, Cremonesi E. Sufentanil added to hyperbaric bupivacaine for subarachnoid block in Caesarean section. Eur J Anaesthesiol 2003; 20(8):631-5.
  19. Delavar P, Ghadyani S, Seyyed Salehi T, Gholami Fasharaki M. Evaluation of the effects and side effects of intrathecal fentanyl and fufentanil in painless labor. Daneshvar Medicine 2011; 18(94):45-52.
  20. Dourado AD, Filho RL, Fernandes RA, Gondim MC, Nogueira EV. Sufentanil in combination with low-dose hyperbaric bupivacaine in spinal anesthesia for cesarean section: a randomized clinical trial. Braz J Anesthesiol 2016; 66(6):622-627.
  21. Ozyilkan NB, Kocum A, Sener M, Caliskan E, Tarim E, Ergenoglu P, et al. Comparison of intrathecal levobupivacaine combined with sufentanil, fentanyl, or placebo for elective caesarean section: a prospective, randomized, double-blind, controlled study. Current therapeutic research 2013; 75:64-70.
  22. Demiraran Y, Ozdemir I, Kocaman B, Yucel O. Intrathecal sufentanil (1.5 microg) added to hyperbaric bupivacaine (0.5%) for elective cesarean section provides adequate analgesia without need for pruritus therapy. J Anesth 2006; 20(4):274-8.
  23. Palmer CM, Cork RC, Hays R, Van Maren G, Alves D. The dose-response relation of intrathecal fentanyl for labor analgesia. Anesthesiology 1998; 88(2):355-61.
  24. Gulhas N, Erdil FA, Sagir O, Gedik E, Togal T, Begec Z, et al. Lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus. J Anesth 2007; 21(2):159-63.
  25. Ganesh A, Maxwell LG. Pathophysiology and management of opioid-induced pruritus. Drugs 2007; 67(16):2323-33.
  26. Schmelz M. Opioidinduzierter Pruritus. Mechanismen und therapeutische Ansätze [Opioid-induced pruritus. Mechanisms and treatment regimens]. Anaesthesist 2009; 58(1):61-5.
  27. Andrew D, Craig AD. Spinothalamic lamina I neurons selectively sensitive to histamine: a central neural pathway for itch. Nat Neurosci 2001; 4(1):72-7.
  28. Szarvas S, Harmon D, Murphy D. Neuraxial opioid-induced pruritus: a review. J Clin Anesth 2003; 15(3):234-9.
  29. Charuluxananan S, Somboonviboon W, Kyokong O, Nimcharoendee K. Ondansetron for treatment of intrathecal morphine-induced pruritus after cesarean delivery. Reg Anesth Pain Med 2000; 25(5):535-9.

The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 24, Issue 3
May 2021
Pages 33-41