PREOPERATIVE GABAPENTIN PREVENTS INTRATHECAL MORPHINE-INDUCED PRURITUS AFTER GYNECOLOGICAL SURGERY
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Abstract
BACKGROUND: Spinal anesthesia with intrathecal morphine has a lower postoperative pain score than general anesthesia, in total abdominal hysterectomy. Pruritus is the most common side effect of intrathecal morphine. Gabapentin is an anticonvulsant that has been reported to relieve in some pruritus conditions. Nevertheless, the dose of gabapentin 600 and 1,200 milligrams for relieving pruritus from intrathecal morphine has been irreconcilable.
OBJECTIVE: to evaluate the efficacy of preoperative gabapentin 900 milligrams, compared with control group, to prevent intrathecal morphine-induced pruritus after gynecological surgery.
METHODS: Prospective randomized control study, 110 patients from gynecology department, Chiangrai Prachanukroh hospital were randomized into 2 groups (Group 0 = control group, Group 1 = gabapentin group). Patients in group1 received 900 milligrams of gabapentin 2 hours before surgery. All patients underwent spinal anesthesia using 3.0-3.8 milliliters of 0.5% hyperbaric bupivacaine, 0.15 mg intrathecal morphine, and evaluated pruritus score at 1,2,3,4,6,8,12,24 hours after administration of intrathecal morphine.
RESULTS: 110 patients completed the trial, 55 in each group. The incidence of pruritus was significantly more frequent in the control group (45 patients) compared with the gabapentin group (34 patient) (81.8% vs 61.8%; p = 0.033). In the gabapentin group, the average pruritus score was decreased by 0.32 score, compared with the placebo group (95% CI -0.53, -0.12; p=0.002).
CONCLUSIONS AND DISCUSSIONS: 900 milligrams of gabapentin, 2 hours before the operation, prevents intrathecal morphine-induced pruritus. In conclusion, we recommend 900 milligrams for preventing the side effects of spinal anesthesia with intrathecal morphine, in patients undergoing gynecological surgery.
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References
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