EPIDURAL-FENTANYL-INDUCED PRURITUS

Abstract

S250 INTRODUCTION: Epidural-PCA fentanyl for post c/s pain provides excellent analgesia but is sometimes associated with pruritus which may be distressing to patients. IV naloxone [1] resulted in a prompt relief of symptoms. Such patients in our institution have been treated by a floor nurse with incremental doses of IV 0.04 mg naloxone. To determine whether patient-administered IV naloxone enhanced patient control and decreased need for hospital staff intervention, we conducted, with IRB approval, a prospective, randomized study of 148 consenting patients who received epidural fentanyl for post c/s pain. METHODS: The patients were randomly allocated in PACU to two groups. Group I: (n=74) received patient administered IV naloxone via PCA device (Abbott Life-Care-Abbott Laboratories, Chicago, IL.), PCA dose 0.04 mg (5 ml) and a lockout time interval of 5 min. Group II: (n=74) upon request from a floor nurse were able to receive IV naloxone 0.04 mg bolus dose every 5 min. The patients were evaluated at 1, 2, and 4 hrs, then every 4 hrs for 24 hrs for: fentanyl and naloxone total doses, fentanyl side effects, VAS pain scores, itching score, overall satisfaction and satisfaction from naloxone treatment. RESULTS: There were no differences among the groups with respect to age, height, weight, and parity data, pain and itching scores, incidence of sedation, nausea, or vomiting, overall satisfaction and satisfaction from itching treatments. GI patients were more likely to complain of itching (79.7% vs. 68.9% of the controls, Chi square = 2.26, 1 df), to receive naloxone treatment (70.3% vs. 37.8% for controls, Chi square = 15.67, 1 df), used more naloxone in 24 hrs (2.4 mg vs. 0.22 mg for the controls, P=0.3), and received more boluses of fentanyl (6.5 ml vs. 4.6 for the controls, P=0.19). However, the total fentanyl administered was comparable between the groups (438.8 [micro sign]g vs. 422.4 [micro sign]g for controls). DISCUSSION: Patient-administered IV naloxone enhanced patient control of treatment of epidural fentanyl-induced itching and decreased need for hospital staff intervention. The significantly greater amount of naloxone used by the self-administered group is strongly suggestive of the need to treat itching in patients who receive epidural-PCA fentanyl for post c/s pain. We believe that giving these patients the ability to administer naloxone on demand makes them more aware of itching that otherwise might go untreated.