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Pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia: a case control study

BACKGROUND: Pruritus is one of the most common side effects of epidural morphine administered for post-surgery analgesia, and pregnant women tend to be highly susceptible. The relative contributions of morphine concentration, local anesthetics, and level of pain to pruritus after epidural morphine f...

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Autores principales: Tian, Xinyi, Niu, Kaifan, Cao, Hong, Zhan, Gonghao, Zhang, Yan, Xu, Feng, Shangguan, Wangning, Gao, Ye
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811233/
https://www.ncbi.nlm.nih.gov/pubmed/33451285
http://dx.doi.org/10.1186/s12884-020-03522-6
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author Tian, Xinyi
Niu, Kaifan
Cao, Hong
Zhan, Gonghao
Zhang, Yan
Xu, Feng
Shangguan, Wangning
Gao, Ye
author_facet Tian, Xinyi
Niu, Kaifan
Cao, Hong
Zhan, Gonghao
Zhang, Yan
Xu, Feng
Shangguan, Wangning
Gao, Ye
author_sort Tian, Xinyi
collection PubMed
description BACKGROUND: Pruritus is one of the most common side effects of epidural morphine administered for post-surgery analgesia, and pregnant women tend to be highly susceptible. The relative contributions of morphine concentration, local anesthetics, and level of pain to pruritus after epidural morphine for post-cesarean delivery analgesia remain unclear. Accordingly, the present study aimed to identify risk factors for pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia. METHODS: This case control study was based on routinely collected clinical data. Participants included women who had undergone cesarean section and adopted a patient-controlled analgesia pump for postoperative analgesia. A series of logistic regression analyses were performed. Interaction terms were added to explore the moderation effects of combined local anesthetics and pain level on associations between morphine concentration and pruritus. Robustness of the results was checked through sensitivity analysis using propensity scores matching approach. RESULTS: Higher morphine concentration, assisted reproductive treatment, and multipara and cesarean section history were significantly more prevalent in the pruritus group than in the control group. The probabilities of pruritus at morphine concentrations of 10, 15, 20, 25, 30 and 40 μg/mL increased sequentially from 0.05, 0.1, 0.2, 0.35, 0.54 to 0.84, respectively. The trend remained steep in the ropivacaine stratum and became flatter when combined with levobupivacaine. At mild pain combined with levobupivacaine, the incidence of pruritus increased from 0.33 (95% confidence interval [CI] 0.1–0.68) in the 10 μg/mL morphine group to 0.48 (95% CI 0.1–0.88) in the 40 μg/mL morphine group. In the stratum of moderate pain combined with levobupivacaine, the incidence increased from 0.4 (95% CI 0.04–0.92) to 0.56 (95% CI 0.03–0.98). The results in the sensitivity analysis were in consistent with above findings. CONCLUSIONS: Higher concentrations of morphine, multipara, and assisted reproductive treatment were factors associated with a higher probability of pruritus. Pain level or combined local anesthetics could moderate the association between morphine concentration and pruritus.
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spelling pubmed-78112332021-01-18 Pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia: a case control study Tian, Xinyi Niu, Kaifan Cao, Hong Zhan, Gonghao Zhang, Yan Xu, Feng Shangguan, Wangning Gao, Ye BMC Pregnancy Childbirth Research Article BACKGROUND: Pruritus is one of the most common side effects of epidural morphine administered for post-surgery analgesia, and pregnant women tend to be highly susceptible. The relative contributions of morphine concentration, local anesthetics, and level of pain to pruritus after epidural morphine for post-cesarean delivery analgesia remain unclear. Accordingly, the present study aimed to identify risk factors for pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia. METHODS: This case control study was based on routinely collected clinical data. Participants included women who had undergone cesarean section and adopted a patient-controlled analgesia pump for postoperative analgesia. A series of logistic regression analyses were performed. Interaction terms were added to explore the moderation effects of combined local anesthetics and pain level on associations between morphine concentration and pruritus. Robustness of the results was checked through sensitivity analysis using propensity scores matching approach. RESULTS: Higher morphine concentration, assisted reproductive treatment, and multipara and cesarean section history were significantly more prevalent in the pruritus group than in the control group. The probabilities of pruritus at morphine concentrations of 10, 15, 20, 25, 30 and 40 μg/mL increased sequentially from 0.05, 0.1, 0.2, 0.35, 0.54 to 0.84, respectively. The trend remained steep in the ropivacaine stratum and became flatter when combined with levobupivacaine. At mild pain combined with levobupivacaine, the incidence of pruritus increased from 0.33 (95% confidence interval [CI] 0.1–0.68) in the 10 μg/mL morphine group to 0.48 (95% CI 0.1–0.88) in the 40 μg/mL morphine group. In the stratum of moderate pain combined with levobupivacaine, the incidence increased from 0.4 (95% CI 0.04–0.92) to 0.56 (95% CI 0.03–0.98). The results in the sensitivity analysis were in consistent with above findings. CONCLUSIONS: Higher concentrations of morphine, multipara, and assisted reproductive treatment were factors associated with a higher probability of pruritus. Pain level or combined local anesthetics could moderate the association between morphine concentration and pruritus. BioMed Central 2021-01-15 /pmc/articles/PMC7811233/ /pubmed/33451285 http://dx.doi.org/10.1186/s12884-020-03522-6 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Tian, Xinyi
Niu, Kaifan
Cao, Hong
Zhan, Gonghao
Zhang, Yan
Xu, Feng
Shangguan, Wangning
Gao, Ye
Pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia: a case control study
title Pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia: a case control study
title_full Pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia: a case control study
title_fullStr Pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia: a case control study
title_full_unstemmed Pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia: a case control study
title_short Pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia: a case control study
title_sort pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia: a case control study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811233/
https://www.ncbi.nlm.nih.gov/pubmed/33451285
http://dx.doi.org/10.1186/s12884-020-03522-6
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