预防性应用喷他佐辛可降低阿片类药物腰麻剖宫产后瘙痒的发生率：前瞻性随机临床试验
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Prophylactic Pentazocine Reduces the Incidence of Pruritus After Cesarean Delivery Under Spinal Anesthesia With Opioids: A Prospective Randomized Clinical Trial
背景与目的
阿片类药物腰麻剖宫产后瘙痒发生率较高，从50%到100%不等。然而，瘙痒很难预防，喷他佐辛已被证明是一种有效的治疗药物。但喷他佐辛对瘙痒的预防效果尚未可知。本随机双盲试验目的是评估术中静脉喷他佐辛对阿片类药物腰麻后第一个24h阿片类药物引起瘙痒的发生率的影响。
方 法
本研究获医院审查委员会批准。纳入的122例择期剖宫产患者签署知情同意书（ASA II级；年龄20-40岁）。0.5%重比重布比卡因10mg、芬太尼10μg、吗啡100μg行腰麻。胎儿胎盘娩出后，随机给予产妇静脉喷他佐辛15mg（1ml）或生理盐水1ml。所有产妇采用0.15%左旋布比卡因行硬膜外术后镇痛。记录腰麻后第一个24小时内出现的瘙痒，以及送回病房时，腰麻注药后第3、 6、12、24小时的瘙痒程度，疼痛数值评分（NRS），不良反应。
结 果
共有119名产妇完成了本项研究。与生理盐水相比（估计69%相对危险度，95% CI，52%，90%；P = 007），静脉喷他佐辛减少了术后第一个24h瘙痒的总发生率，也降低了瘙痒程度。恶心呕吐发生率和术后疼痛NRS评分无统计学差异。
结 论
腰麻药中加入了阿片类药物的剖宫产患者，分娩后静脉单次喷他佐辛15mg可降低瘙痒的发生率和严重程度。
原始文献摘要
Hirabayashi M, Doi K, Imamachi N, et al. Prophylactic Pentazocine Reduces the Incidence of Pruritus After Cesarean Delivery Under Spinal Anesthesia With Opioids: A Prospective Randomized Clinical Trial[J].Anesth Analg, 2017,124(6):1930-1934. doi: 10.1213/ANE.0000000000002060.、
BACKGROUND: The incidence of pruritus after cesarean delivery under spinal anesthesia with opioids is high, ranging from 50% to 100%. Pruritus is difficult to prevent; however, pentazocine has been shown to be an effective treatment. Despite this, the prophylactic effect of pentazocine on pruritus has not been defined. This randomized double-blind trial aimed to evaluate the effect of intraoperative IV pentazocine on the incidence of opioid-induced pruritus within the first 24 hours after administration of neuraxial opioids.
METHODS: We obtained institutional review board approval and written informed consent from the 122 patients (American Society of Anesthesiologists [ASA] physical status II; aged 20-40 years) scheduled for elective cesarean delivery who were included in this study. Spinal anesthesia was performed with 10 mg of 0.5% hyperbaric bupivacaine, 10 μg of fentanyl, and 100 μg of morphine. After delivery of the baby and placenta, the parturient women were randomized to intravenously receive 15 mg (1 mL) of pentazocine or 1 mL of saline. All women received postoperative analgesia with the epidural infusion of 0.15% levobupivacaine. The presence of pruritus within the first 24 hours after intrathecal administration of opioids was recorded, and severity of itch, numerical rating scale (NRS) for pain, and adverse effects were also recorded at the time of the arrival on the ward, as well as 3, 6, 12, and 24 hours after the intrathecal administration of opioids.、
RESULTS: A total of 119 women completed the study. IV pentazocine reduced the overall incidence of pruritus within the first 24 hours compared to IV saline, with an estimated relative risk of 69% (95% confidence interval [CI], 52%, 90%; P = .007). IV pentazocine also reduced the severity of pruritus. The incidence of nausea and vomiting was not significantly different. There were no significant differences in postoperative NRS scores.、
CONCLUSIONS: A single 15-mg dose of IV pentazocine after delivery can reduce both the incidence and severity of pruritus in women who have received subarachnoid opioids during cesarean delivery.
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