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BJA Advance Access published online on April 5, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael072
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted January 17, 2006

Clinical Investigation

Study of the prophylactic effect of droperidol, alizapride, propofol and promethazine on spinal morphine-induced pruritus

M. L. Horta 1 *, L. C. L. Morejon 1, A. W. da Cruz 1, G. R. dos Santos 1, L. C. Welling 1, L. Terhorst 1, R. C. Costa 1, and R. U. Z. Alam 1

1 Department of Anaesthesiology, Hospital Universitário São Francisco de Paula da UCPEL, Pelotas, RS, Brazil; Department of Anaesthesiology, Santa Casa de Misericórdia de Pelotas, Pelotas, RS, Brazil

* To whom correspondence should be addressed.
M. L. Horta, E-mail: marciolhorta{at}uol.com.br


  Abstract

Background. We have compared the use of alizapride, propofol, droperidol and promethazine for the prevention of spinal morphine-induced pruritus.

Methods. Three hundred ASA I or II women undergoing Caesarean section under spinal anaesthesia, in which morphine 0.2 mg was added to a local anaesthetic, were assigned randomly to receive i.v., in the operating room, just after delivery of the baby, alizapride 100 mg, propofol 20 mg, droperidol 1.25 mg, promethazine 50 mg or saline 2 ml (control group). In the postoperative period, the women were assessed for pruritus (absent, mild, moderate or severe) or other untoward symptoms by blinded observers. We used 95% confidence limits (95% CI) for the cumulative incidence of moderate and severe pruritus to compare the groups, and the NNT and 95% CI to compare droperidol, propofol and alizapride as for their effectiveness in preventing pruritus. For other untoward effects, the {chi}2-test was used, results being considered significant when P<0.05.

Results. The droperidol, propofol and alizapride groups had significantly lower incidences of pruritus compared with the control and promethazine groups, while the incidence of pruritus was similar among the patients assigned to the promethazine and control groups. As for the prevention of moderate and severe pruritus, droperidol had the lowest NNT (3.52; 95% CI: 3.37-3.67), followed by propofol (4.61; 95% CI: 4.45-4.77) and alizapride (5.43; 95% CI: 5.27-5.59). As for untoward effects, droperidol and promethazine increased the incidence of somnolence, which seemed more severe with promethazine. Otherwise, there were no differences between the groups.

Conclusion. Droperidol, propofol and alizapride, in a decreasing order of effectiveness in the doses used in this study, reduced the incidence of pruritus induced by the use of morphine 0.2 mg intrathecally. On the other hand, promethazine 50 mg was shown to be ineffective.

Keywords: anaesthetics i.v., propofol; analgesics opioid, morphine; antihistamines, promethazine; complications, pruritus; hypnotics butyrophenone, droperidol; pharmacology, alizapride.
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Study of the prophylactic effect of droperidol, alizapride, propofol and promethazine on spinal morp
Marilise Galea
British Journal of Anaesthesia, 14 Jun 2006 [Full text]

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