The Effect Of Hydromorphone In Patient-Controlled Epidural Analgesia On Pruritus Compared With Morphine After Cesarean Section

Objective: To compare the effect of hydromorphone or morphine in patient-controlled epidural analgesia on pruritus after cesarean section, and preliminary study on the relationship between serotonin and hydromorphone or morphine-induced pruritus by detecting the itching media serotonin level in peripheral blood of puerperant.Methods: Sixty full-term pregnant women scheduled for cesarean section,ASA I or II, were random double-blindly divided into hydromorphone group(group HM)and morphine group(group M),thirty cases in each group. All the patients received low-segment cesarean section under combined spinal-epidural anesthesia( CSEA), and postoperative patient-controlled analgesia with hydromorphone and morphine. At 1,6,12 and 24 hours after analgesia,Numeric Rating Scale(NRS),Ramsay Sedation Scale,Bruggman Comfort Scale(BCS),total pressing times 24 h after PCEA and the incidence and severity of itch were recorded,meanwhile,take blood samples 5min before analgesia(T0)and 5min(T1),15min(T2),30min(T3),60min (T4),120min(T5) after analgesia to detect the concentration of serotonin in peripheral blood by using enzyme linked immunosorbent assay.Results:1.At 1h,6h after analgesia,NRS score had no statistical differences in two groups(P>0.05),and the differences were significant at 12 h,24h after analgesia(P<0.05).2.There were no significant statistical differences in two groups of the total pressing times 24 h after PCEA(P>0.05).3.At 1h?6h?12h after analgesia,Ramsay score had no statistical differences in two groups(P>0.05),and the differences were significant at 24 h after analgesia(P<0.05).4.At 1h?6h after analgesia,BCS score had no statistical differences in two groups(P>0.05),and the differences were significant at 12 h,24h after analgesia(P<0.05).5.There were no statistical differences in two groups of the mild and moderate pruritus(P>0.05),and the incidence of post-operation pruritus and severe itching had significant differences(P<0.05).6.At 30min(T3),60min(T4),120min(T5)after analgesia,the level of serotonin in serum had significant differences in two group(P<0.05),and the differences were no significant at 5min(T0)before analgesia and 5min(T1),15min(T2)after analgesia(P<0.05).Conclusions:1.The analgesia and sedation effect of postoperative epidural analgesia with hydromorphone in patients undergoing cesarean section was satisfactory,better comfortable, and the incidence of pruritus were lower than that of morphine.2.Patient-controlled analgesia with hydromorphone or morphine can all increased the serotonin level in the peripheral blood of patient undergoing cesarean section, and the intensity of serotonin released by morphine was higher than that of hydromophone.3.Serotonin may be involved in the mechanism of the occurrence of pruritus in patient-controlled epidural analgesia with hydromorphone or morphine after cesarean section.