Education and Ethics In Nursing ISSN: 2322-5300

Investigating the degree of pruritus caused by intrathecal fentanyl injection in opium-addicted patients in lower limb orthopedic surgery with spinal anesthesia: Study protocol for a randomized controlled trial

https://doi.org/10.22034/ethic.2024.2035421.1089
Volume 13, special issue
July 2024
Pages 103-109
Education and Ethics In Nursing ISSN: 2322-5300

Document Type : protocol study

Authors

Seyedeh Roya Mousavi 1
Parvaneh Ebrahimzadeh 1
Sepideh Yazdanpanah 2
Nasim Asadat Mousavi 3
Mansour Deylami 4

1 Assistant Professor of Anesthesiology, Department of Anesthesiology and Critical Care, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran

2 Departement of Anesthesiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran

3 Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran

4 Assistant Professor, Department of Anesthesiology, Golestan University of Medical Sciences, Gorgan, Iran

Abstract
Introduction: Addicted patients have more resistance to local anesthetic drugs when they are used to perform peripheral and central nerve blocks. Therefore, many drugs are added to local anesthetics to enhance their analgesic properties, one of the most common of which is narcotic compounds. Itching caused by opium may be generalized and often occurs shortly after injection. Therefore, the present study aimed to investigate the amount of itching caused by intrathecal injection of fentanyl in opium addicts who underwent elective orthopedic surgeries of the lower limbs with spinal anesthesia.
Methods & Materials: This study was a double-blind clinical trial on 68 opium-addicted patients who are candidates for elective orthopedic surgeries of the lower limbs under spinal anesthesia. Patients were divided into 2 groups using random numbers table; Intervention (intrathecal marcaine spinal anesthesia with fentanyl) and control (marcaine spinal anesthesia). Itching, hemodynamic symptoms (mean arterial pressure, heart rate and percentage of arterial blood oxygen saturation), nausea and vomiting were evaluated in both groups. Data analysis was done by descriptive statistics indicators (mean, standard deviation, percentage, number, frequency) and inferential statistical tests (Fisher, chi-square, independent t, Mann-Whitney) using spss software version 20. P<0.05 was considered as a significant level in all tests.
Discussion: This study investigated the effect of pruritus on intrathecal fentanyl injection in opium-addicted patients in lower limb orthopedic surgeries, so that if the result of the study shows an increase in pruritus in addicted patients, it is recommended to reduce the dose of fentanyl with Alternative medicines that used.

Keywords

Intrathecal
Fentanyl
Addiction
Itching
  1. Elia N, Culebras X, Mazza C, Schiffer E, Tramèr MR. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials. Reg Anesth Pain Med. 2008;33(2):159–67.
  2. M J Christie, J T Williams and R A North. Cellular mechanisms of opioid tolerance: studies in single brain neurons. Molecular Pharmacology November 1987, 32 (5) 633-638.
  3. Adhikary, S., Jaeckel, E. R., and Birdsong, W. T. (2022a). Mu opioid receptors acutely regulate adenosine signaling in striatal glutamate afferents. J. Neurosci. 12, 2404–2417.
  4. Adhikary, S., Koita, O., Lebowitz, J. J., Birdsong, W. T., and Williams, J. T. (2022b). Agonist specific regulation of G protein-coupled receptors after chronic opioid treatment. Mol. Pharmacol. 5, 300–308.
  5. Arttamangkul, S., Heinz, D. A., Bunzow, J. R., Song, X., and Williams, J. T. (2018). Cellular tolerance at the μ-opioid receptor is phosphorylation dependent. Elife 7:e343989.
  6. Kouzehgaran S, Saber-Tanha A. What Is the Main Reason for Reduction in Duration of Action of Local Anesthetics Used for Spinal Anesthesia in Opium Addicted Patients? Addict Health. 2015;7(3-4):198.
  7. Vosoughian M, Dabbagh A, Rajaei S, Maftuh H. The duration of spinal anesthesia with 5% lidocaine in chronic opium abusers compared with nonabusers. Anesthesia and analgesia. 2007;105(2):531-3
  8. Mirkheshti A, Saadatniaki A, Salimi A, Manafi Rasi A, Memary E, Yahyaei H. Effects of dexmedetomidine versus ketorolac as local anesthetic adjuvants on the onset and duration of infraclavicular brachial plexus block. Anesth Pain Med. 2014;4(3):e17620.
  9. Stoelting RK, Miller RD: Basics of anesthesia. 5nd ed. London Churchill Livingstone; 2007.
  10. Bujedo BM. An Update on Neuraxial Opioid Induced Pruritus Prevention. J Anesth Crit Care Open Access 2016; 6(2):00226.
  11. Cevikbas F, Lerner EA. Physiology and Pathophysiology of Itch. Physiol Rev. 2020 Jul 1;100(3):945-982. 
  12. Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology. 2001;94(5):888–906.
  13. Sattari H, Taravati H, Karimi A, Dehghani A. Investigating the Effects of Adding Fentanyl to Bupivacaine in Spinal Anesthesia of Opium-addicted Patients. JSSU 2014; 22 (4) :1396-1405
  14. Safari F, Mottaghi K, Hashem Aghayi F, Nashibi M. Comparison of dexmedetomidine and Midazolam as adjuvants ti intratechal bupivacaine on the duration of block in opium addicted patient's candidate for lower extremity surgery. JASAIC. 2016; 38(94): 20-28.
  15. Lord Lasemi, S., Delavar, P., Hadavand, S. Prevalence of pruritus following Intrathecal fentanyl and sufentanil after spinal anesthesia in cesarean section. The Iranian Journal of Obstetrics, Gynecology and Infertility, 2021; 24(3): 33-41.
  16. Gropper MA, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Leslie K. Miller's anesthesia, 2-volume set E-book: Elsevier Health Sciences; 2019.

 

Home

Guide for Authors

Submit Manuscript

Contact Us