A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Medicine (In the branch of Anaesthesiology). February 2013 / BACKGROUND AND OBJECTIVES: Local anaesthetic agent mixed with an opioid provides effective, fast and reliable onset of regional analgesia. However, the intrathecal use of opioids may have undesirable effects, one of which is pruritus (itching). The main objectives of this study were to assess the incidence and severity of fentanyl-induced pruritus in patients who received spinal anaesthesia for caesarean section at Chris Hani Baragwanath Academic Hospital, and to determine the influence of factors such as dosage of fentanyl, age, race, and socio-economic status on the perception of pruritus. METHODS: This was a prospective observational study of obstetric patients delivered by elective caesarean section under spinal anaesthesia at Chris Hani Baragwanath Academic Hospital. Regional anaesthesia was performed following a departmental protocol where patients received 0.5% bupivacaine with dextrose mixed fentanyl. The departmental protocol was used as a guideline for the mixture but the different anaesthetists were not restricted to it. Based on their practice, a range of fentanyl doses were used. The participants were observed for pruritus directly intraoperatively by the researcher, and again at approximately one hour after spinal anaesthetic administration. This last observation was complemented by means of a structured interview. Severity was assessed using a visual analogue scale. For descriptive analysis, to show a 95% confidence interval of no more than 10% around an observed percentage of patients with pruritus, a sample size of 96 participants was chosen. Page | 6 RESULTS: The overall incidence of pruritus in 96 participants who received intrathecal fentanyl was 54.2%. Pruritus occurred in 48 participants (50.0%) during the caesarean section. Four participants (4.2%), who had no pruritus intraoperatively, developed it one hour after the spinal anaesthetic was administered. The part of the body commonly affected was the nose. The severity of pruritus was more than tolerable in 6 participants (6.3%), with two of them perceiving it as unbearable. No participant reported pruritus 24 hours after the spinal anaesthetic. There was no statistically significant association between the frequency of pruritus and the dose of fentanyl, age, race and socio-economic status indicators. CONCLUSION: Pruritus is a common symptom in women undergoing caesarean section using fentanyl-containing neuraxial block. However, most cases are mild and not related to dosage. Women who complain of intraoperative or postoperative pruritus can be informed that the symptom is transient and of no serious clinical consequence.

No description available.

Made available in DSpace on 2014-06-11T19:30:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2002Bitstream added on 2014-06-13T19:40:10Z : No. of bitstreams: 1 horta_ml_dr_botfm.pdf: 310795 bytes, checksum: f93f33ec3d563d0324729fb29f529e81 (MD5) / Vários antieméticos têm sido utilizados contra o prurido provocado pela morfina, utilizada por via peridural ou por via subaracnóidea. As diferenças de perfil farmacodinâmico entre as diversas drogas do grupo das benzamidas substituídas motivaram o estudo da alizaprida, embora a metoclopramida já se houvesse mostrado inativa com relação a esse aspecto. Em estudo duplo-cego, foram estudadas 84 mulheres submetidas a cesariana sob anestesia subaracnóidea (100 mg de lidocaína pesada a 5% e 0,2 mg de morfina), distribuídas aleatoriamente em dois grupos de 42 pacientes. Logo após o nascimento da criança, eram injetados, por via intravenosa, 50 mg de alizaprida (Grupo Alizaprida), ou 10 mg de metoclopramida (Grupo Controle). No período pós-operatório, as pacientes foram avaliadas com relação ao prurido (ausente, leve, moderado ou intenso) ou a outros efeitos adversos. Para as comparações entre porcentagens, foi utilizado o teste do Qui-quadrado, com a correção de Yates no caso de tabelas 2 x 2. Para as comparações entre porcentagens, foi utilizado o teste do Qui-quadrado, com a correção de Yates no caso de tabelas 2 x 2. Para as comparações entre médias, foi utilizada a análise de variância. Os valores foram considerados significativos quando P < 0,05. A alizaprida, usada na dose de 50 mg por via intravenosa, produziu uma redução na intensidade do prurido (P < 0,05), sem alteração da incidência de outros possíveis efeitos colaterais avaliados (hipotensão, sonolência, etc.) / Several antiemetic drugs have been shown to be effective against epidural or spinal morphine-induced pruritus. The pharmacodynamic differences among the drugs in the substituted benzamide group motivated the study of alizapride, though metoclopramide has already been shown not to alter this side effect. In a double-blind study, 84 womem submitted to cesarean under spinal anesthesia (100 mg of 5% hyperbaric lydocaine plus 0,2 mg of morphine) were randomly divided into two groups of 42 patients. Just after birth, they were injected intravenously either 50 mg of alizapride (Alizapride group) or 10 mg of metoclopramide (Control group). In the postoperativge period, they were assessed as for pruritus (absent, mild, moderate or severe) or any other side-effects. Percentages were compared using the chi-square test, with Yates correction in the case of 2 x 2 tables. Means were compared using the analysis of variance. Values were considered as significant when p < .05. Alizapride, in the conditions it was used, reduced severity of pruritus (p < .05) without altering the incidence of any other assessed side effects (hypotension, somnolence, etc.)

No description available.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第17822号 / 医博第3820号 / 新制||医||999(附属図書館) / 30637 / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 鈴木 茂彦, 教授 三森 経世 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Uremic pruritus remains one of the most frustrating and potentially disabling symptoms in patients with endstage renal disease. It affects up to 90% of patients on dialysis. Several hypotheses have been postulated for the possible underlying etiology, but none is conclusive. Aside from kidney transplantation, which is the only definitive treatment, therapeutic approaches have largely been empirical, and no firm evidence-based treatments are available. The main goal of therapy remains to minimize the severity of pruritus and improve the quality of life especially among those who are not transplantation candidates or are waiting for surgery.

O prurido (agudo e crônico) é uma sensação desagradável, que provoca o desejo ou o reflexo de coçar-se. Estima-se que 23 a 44 milhões de norte americanos sofrem com prurido, mas os dados epidemiológicos da frequência e as causas do prurido são escassos em vários países, incluindo Brasil. Os anti-histamínicos constituem os principais fármacos para tratar alergias e prurido provocado por picadas de insetos, mas são ineficazes conta o prurido idiopático, crônico e generalizado. Curiosamente, a exposição primária de humanos e animais à picada do mosquito fêmea Aedes aegypti (A. aegypti) não induz prurido, e pouco se sabe sobre este efeito. Neste contexto, este estudo caracterizou, via emprego de abordagens farmacológicas, o efeito do extrato da glândula salivar (EGS) do mosquito A. aegypti sobre o prurido (e inflamação cutânea relacionada) induzido por vias histaminérgicas (ou não) em pele dorsal de camundongos. A indução do prurido agudo (inflamação cutânea) foi feita pela injeção intradérmica (i.d) do composto 48/80 (C48/80), agonistas de Receptores Ativados por Protease -2 (PAR-2 (SLIGRL), receptores acoplados a proteína G do tipo mas (Mrgrp (cloroquina) e de potencial transitório TRPA1 e TRPV1 (allyl isothiocyanate e capsaicina, respectivamente) em Tyrode. O EGS do A. aegypti, (0,3 a 3 <font face = \"symbol\">mg/sitio, i.d.) inibiu o prurido, edema e influxo de células frente ao C48/80 em pele murina, mas não protegeu da desgranulação do mastócito in vitro, indicando que componentes bioativos no EGS inibem o prurido e a inflamação dependentes de vias histaminérgicas. O EGS reduziu parcialmente o prurido (ou inflamação neurogênica) induzido por SLIGRL, cloroquina, AITC ou capsaicina na pele murina, sugerindo que outros componentes bioativos afetam disparos nervosos pruriceptivos de vias não histaminérgicas. O estudo in vitro veio igualmente esclarecer que moléculas conservadas no EGS inibem respostas nervosas aos agonistas TRPV1 e TRPA1 em cultura de células de neurônios ou linhagem HEK293t transfectada (hTRPV1 e hTRPA1). Este estudo mostrou, pela primeira vez, a caracterização farmacológica anti-pruriceptiva (e anti-inflamatória) do EGS do mosquito fêmea A. aegypti, cujo mecanismo inclui vias sensível e resistente a histamina, podendo o EGS representar um nova ferramenta farmacológica com potencial para o controle do prurido. / Pruritus (acute and chronic) is an unpleasant sensation, which causes the desire or the reflex of scratching. It is estimated that 23 to 44 million Americans suffer from pruritus, but epidemiological data on pruritus frequency and its causes are scarce in several countries, including Brazil. Antihistamines are the main drugs to treat allergies and pruritus caused by insect bites, but they are ineffective to treat idiopathic, chronic and generalized pruritus. Interestingly, a primary exposure of humans and animals to the bite of the female mosquito Aedes aegypti (A. aegypti) does not induce pruritus, and little is known about this effect. In this context, this study characterized, through the use of pharmacological approaches, the effect of the salivary gland extract (EGS) of the A. aegypti mosquito on pruritus (and related cutaneous inflammation) induced by histaminergic or non histaminergic pathways in the dorsal skin of mice. The induction of acute pruritus (and or cutaneous inflammation) was produced by the intradermal (i.d.) injection of compound 48/80 (C48/80), agonists Protease Activated Receptor -2 (PAR-2 (SLIGRL), mas-related G protein-coupled receptor (Mrgrp (chloroquine) and transient receptor potential TRPA1 and TRPV1 (allyl isothiocyanate and capsaicin, respectively) diluted in Tyrode. The A. aegypti SGE, (0.3 to 3 <font face = \"symbol\">mg/site, id) significantly inhibited pruritus, edema and neutrophil influx evoked by C48/80 in murine skin, but it did not protect against mast cell degranulation in vivo and in vitro. This suggests that EGS bioactive components inhibit pruritus and inflammation via mechanism dependent on histaminergic pathways. SGE partially reduced SLIGRL, chloroquine, AITC-induced pruritus, or capsaicin-induced neurogenic inflammation in murine skin, suggesting that SGE bioactive components affect pruriceptive nerve firing independently of histaminergic pathways. The in vitro study also clarified that conserved SGE molecules inhibit nerve responses to TRPV1 and TRPA1 agonists in cultured neurons of dorsal root ganglia or transfected HEK293t lineage (hTRPV1 and hTRPA1). This study showed, for the first time, the anti-pruriceptive (and anti-inflammatory) pharmacological characterization of the EGS from the A. aegypti female mosquito, whose mechanism includes sensitive and histamine-resistant pathways. EGS may represents a new pharmacological tool with potential to treat pruritus.

Orientador: Pedro Thadeu Galvão Vianna / Resumo: Vários antieméticos têm sido utilizados contra o prurido provocado pela morfina, utilizada por via peridural ou por via subaracnóidea. As diferenças de perfil farmacodinâmico entre as diversas drogas do grupo das benzamidas substituídas motivaram o estudo da alizaprida, embora a metoclopramida já se houvesse mostrado inativa com relação a esse aspecto. Em estudo duplo-cego, foram estudadas 84 mulheres submetidas a cesariana sob anestesia subaracnóidea (100 mg de lidocaína pesada a 5% e 0,2 mg de morfina), distribuídas aleatoriamente em dois grupos de 42 pacientes. Logo após o nascimento da criança, eram injetados, por via intravenosa, 50 mg de alizaprida (Grupo Alizaprida), ou 10 mg de metoclopramida (Grupo Controle). No período pós-operatório, as pacientes foram avaliadas com relação ao prurido (ausente, leve, moderado ou intenso) ou a outros efeitos adversos. Para as comparações entre porcentagens, foi utilizado o teste do Qui-quadrado, com a correção de Yates no caso de tabelas 2 x 2. Para as comparações entre porcentagens, foi utilizado o teste do Qui-quadrado, com a correção de Yates no caso de tabelas 2 x 2. Para as comparações entre médias, foi utilizada a análise de variância. Os valores foram considerados significativos quando P < 0,05. A alizaprida, usada na dose de 50 mg por via intravenosa, produziu uma redução na intensidade do prurido (P < 0,05), sem alteração da incidência de outros possíveis efeitos colaterais avaliados (hipotensão, sonolência, etc.) / Abstract: Several antiemetic drugs have been shown to be effective against epidural or spinal morphine-induced pruritus. The pharmacodynamic differences among the drugs in the substituted benzamide group motivated the study of alizapride, though metoclopramide has already been shown not to alter this side effect. In a double-blind study, 84 womem submitted to cesarean under spinal anesthesia (100 mg of 5% hyperbaric lydocaine plus 0,2 mg of morphine) were randomly divided into two groups of 42 patients. Just after birth, they were injected intravenously either 50 mg of alizapride (Alizapride group) or 10 mg of metoclopramide (Control group). In the postoperativge period, they were assessed as for pruritus (absent, mild, moderate or severe) or any other side-effects. Percentages were compared using the chi-square test, with Yates correction in the case of 2 x 2 tables. Means were compared using the analysis of variance. Values were considered as significant when p < .05. Alizapride, in the conditions it was used, reduced severity of pruritus (p < .05) without altering the incidence of any other assessed side effects (hypotension, somnolence, etc.) / Doutor

Itch/pruritus can be very distressing in palliative care population and often is difficult to treat. Conventional antihistamines lack efficacy. Cutaneous and central pathogenesis of itch is extremely complex and unclear, making its treatment challenging. Neuronal mechanisms have been identified in the pathophysiology of itch hence providing a myriad of therapeutic options. It has been established that pruritus and pain neuronal pathway interact with each other, hence neuropathic analgesics like gabapentin has shown to be efficacious antipruritic therapeutic option. Gabapentin impedes transmitting nociceptive sensations to brain, thus also suppressing pruritus. Gabapentin is safe and found to be effective in uremic pruritus, cancer/hematologic causes, opiod-induced itch, brachioradial pruritis, burns pruritus, and pruritus of unknown origin. Further research is required in this area to establish whether gabapentin is consistently effective.

Itch/pruritus can be very distressing in palliative care population and often is difficult to treat. Conventional antihistamines lack efficacy. Cutaneous and central pathogenesis of itch is extremely complex and unclear, making its treatment challenging. Neuronal mechanisms have been identified in the pathophysiology of itch hence providing a myriad of therapeutic options. It has been established that pruritus and pain neuronal pathway interact with each other, hence neuropathic analgesics like gabapentin has shown to be efficacious antipruritic therapeutic option. Gabapentin impedes transmitting nociceptive sensations to brain, thus also suppressing pruritus. Gabapentin is safe and found to be effective in uremic pruritus, cancer/hematologic causes, opiod-induced itch, brachioradial pruritis, burns pruritus, and pruritus of unknown origin. Further research is required in this area to establish whether gabapentin is consistently effective.