BACKGROUND: The addition of morphine to intrathecal or epidural anesthesia provides an effective, long-lasting postoperative analgesia. However, a common side effect is pruritus which occurs in up to 80 percent of subjects. This study was designed to determine the minimal effective dose of nalbuphine HCI in the treatment and amelioration of morphine-induced pruritus. METHODS: In a prospective, blinded study, 50 patients, 18 to 65 years old who developed pruritus after administration of morphine (intrathecal and epidural) were randomly assigned into 2 groups, Group A received nalbuphine 1 mg/IV every five minutes until pruritus was relieved while Group B received diphenhydramine 50 mg/IV for pruritus. Pruritus scores before and after administration of the drugs were recorded. Data gathered were analyzed using descriptive statistics, students t-test, linear regression and determination of ED50. RESULTS: There was no significant difference between the quality of pain relief between groups A and B. ED50 was noted to occur at 5 mg/IV (the dose in which 50 percent of subjects responded). No significant difference was noted with regards to the ability to relieve pain and the ability to antagonize morphine and its analgesic property. In conclusion, the minimum effective dose of Nalbuphine HCI for amelioration of morphine-induced pruritus is 5 mg per IV. (Author)
Human ; ANESTHESIA ; EPIDURAL, ANESTHESIA ; INTRATHECAL, ANESTHESIA ; ANALGESIA ; ANESTHESIOLOGY ; PRURITUS ; NALBUPHINE HYDROCHLORIDE ; MORPHINE

The clavipectoral fascial plane block was introduced by Dr. Luis Valdes in a symposium at the 2017 European Society of Regional Anesthesia and Pain Therapy Congress. Case: Clavipectoral plane block (CPB) with intravenous sedation provided surgical anesthesia and analgesia in a 39-year-old male patient with a right midshaft clavicle fracture. This in-plane technique was used to deposit 30 ml of a local anesthesia mixture between the clavipectoral fascia and periosteum on both the medial and lateral sides of the fracture line. Conclusions: Excellent anesthesia and analgesia for up to 16 h post-block were provided by CPB during the clavicle surgery.