Table 1.
Prophylactic Use: Overview of Results of Administrating Study Medicine Before or at the Same Time as Spinal Morphine
| Medication Group | No. of Studies | Used Medication from Groupa | Administration Medicationa | Compared to a | Effectiveness | |
|---|---|---|---|---|---|---|
| Pruritus Preventiona, b | Pruritus Severitya, b | |||||
| 5HT-3 Antagonist | 9 | Ondansetron: 6 Dolasetron: 1 Mirtazapine: 2 Palonosetron: 1 |
Intravenous: 7 Per os: 4 |
Control: 7 Medication: 2 |
Superior: 6 (n.a. 0) Specifications: vs con/vs med: 6/0 IV/ PO: 4/3 Before/same time: 6/0 |
Superior: 5 (n.a. 3) Specifications: vs con/vs med: 5/0 IV/ PO: 2/3 Before/same time: 5/0 |
| α2-receptor agonists | 4 | Clonidine: 4 | Intrathecal: 2 Per os: 2 |
Control: 4 Medication: 0 |
Superior: 0 (n.a. 0) | Superior: 0 (n.a. 1) |
| Opioid antagonist | 7 | Naloxone: 5 Naltrexone: 1 Methylnaltrexone: 1 |
Intravenous: 3 Intrathecal: 2 Epidural: 1 Per os: 1 |
Control: 6 Medication: 1 |
Superior: 2 (n.a. 3) Specifications: vs con/vs med: 2/0 IV/ IT: 1/1 Before/same time: n.a./2 |
Superior: 4 (n.a. 2) Specifications: vs con/vs med: 4/0 IV /IT/ Epi/ PO: 1/ 1/ 1/ 1 Before/same time: n.a./4 |
| Opioid agonist/antagonists | 9 | Nalbuphine: 6 Butorphanol: 4 |
PCA: 1 Intrathecal: 2 Epidural: 5 Intramuscular: 1 |
Control: 9 Medication: 1 |
Superior: 6 (n.a. 1) Specifications: vs con/vs med: 6/1 PCA/ IT/ Epi/ IM: 1/2/3/1 Before/same time: n.a./6 |
Superior: 5 (n.a. 3) Specifications: vs con/vs med:5/n.a. PCA/ IT/ Epi: 1/1/3 Before/same time: n.a./5 |
| Corticosteroids | 4 | Dexamethasone: 4 | Intravenous: 2 Intrathecal: 1 Intramuscular: 1 |
Control: 2 Medication: 3 |
Superior: 1 (n.a. 0) Specifications: vs con/vs med: 1/ IV/ IT/ IM: 0/1/0 Before/same time: n.a./1 |
Superior: 0 (n.a. 4) |
| Dopamine antagonists | 3 | Droperidol: 3 | Epidural: 3 | Control: 3 Medication: 0 |
Superior: 2 (n.a. 0) Specifications: vs con/vs med: 2/n.a. Epi: 2 Before/same time: n.a./2 |
Superior: 2 (n.a. 0) Specifications: vs con/vs med: 2/n.a Epi: 2 Before/same time: n.a./2 |
| Epinephrine | 4 | Epinephrine: 4 | Intrathecal: 2 Epidural: 2 |
Control: 4 Medication: 0 |
Superior: 0 (n.a. 0) Inferior vs plain epidural: 1 |
Superior 0 (n.a. 0) Inferior vs plain epidural: 2 |
| NMDA-receptor antagonists | 4 | Ketamine: 3 Magnesium sulphate: 1 |
Epidural: 4 | Control: 4 Medication: 0 |
Superior: 1 (n.a. 0) Specifications: vs con: 1/n.a. Epi: 1 Before/same time: n.a./1 |
Superior: 0 (n.a. 4) |
| NSAID’s | 2 | Diclofenac: 1 Ketorolac: 1 |
Intramuscular: 1 Rectal: 1 |
Control: 2 Medication: 0 |
Superior: 0 (n.a. 1) |
Superior: 1 (n.a. 1) Specifications: vs con: 1 IM/ Rec: n.a./1 Before/same time: n.a./1 |
| Propofol | 2 | Propofol: 2 | Intravenous: 2 | Control: 1 Medication: |
Superior: 2 (n.a. 0) Specifications: vs con/vs med: 1/1 IV: 2 Before/same time: 1/1 |
Superior: 2 (n.a. 0) Specifications: vs con/vs med: 1/1 IV: 2 Before/same time: 1/1 |
| Other study treatments | 6 | Acupuncture: 1 Gabapentin: 3 Midazolam: 1 Chloroprocaine I.T.: 1 |
Per os: 3 (gabapentin) Intravenous: 1 (midazolam) Intrathecal: 1 (chloroprocaine) |
Superior: 3 Specifications: Gabapentin: 2 vs control Midazolam: 1 vs contro |
Superior: 2 Specifications: Gabapentin: 1 vs con Midazolam: 1 vs con |
|
Notes: aStudies that fall in multiple categories are mentioned multiple times, ie for studies comparing the same medication with different administration, or studies comparing two medicaments of the same group. b Overview and specifications of studies showing effectiveness. Not all studies provided information on both prevention and severity of pruritus, indicated by n.a. Overview of study results assessing the prophylactic effectiveness of study medication administered before or at the same time as morphine. Values are presented as n=number of studies.
Abbreviations: vs con, comparison between study medication and control (placebo or nothing); vs med, comparison between two different study medications; IV, intravenous; PCA, patient-controlled anesthesia; IT, intrathecal; Epi, epidural; PO, per os; Rec, rectal; n.a, not available.