SUBHYPNOTIC DOSES OF PROPOFOL RELIEVE PRURITUS INDUCED BY EPIDURAL AND INTRATHECAL MORPHINE

We investigated the efficacy of subhypnotic doses of propofol for spin al morphine-induced pruritus in a prospective, randomized, double-blin d, placebo-controlled study. Fifty patients, ASA physical status 1-3, with spinal morphine-induced pruritus were allocated to receive either 1 ml propofol (10 mg) or 1 ml placebo (Intralipid) intravenously afte r gynecologic, orthopedic, thoracic, or gastrointestinal surgery. In t he absence of a positive response, a second drug treatment was given 5 min later. The persistence of pruritus 5 min after the second treatme nt dose was considered a treatment failure. All failures then received , in an open fashion, a supplementary dose of propofol (10 mg) and wer e reevaluated 5 min later. Both groups were well matched. The success rate was significantly greater in the propofol group (84%) than in the placebo (16%) group (P < 0.05). Ninety percent of the treatment failu res in the placebo group were successfully treated by a supplementary dose of 10 mg propofol. Eight percent of the patients (4% in each grou p) were resistant to all treatments, including naloxone 0.08 mg intrav enously. Three patients had a slight increase in sedation in the propo fol group versus none in control (not significant). The beneficial eff ect of treatment was longer than 60 min in 85% of patients in the prop ofol group and in 100% of the controls (not significant). These result s suggest that propofol in a subhypnotic dose is an efficient drug tre atment for spinal morphine-induced pruritus. At the dose administered (10 mg), side effects were rare and minor.