Prophylactic mirtazapine reduces intrathecal morphine-induced pruritus.

Author(s): Sheen MJ, Ho ST, Lee CH, Tsung YC, Chang FL, Huang ST

Affiliation(s): Department of Anaesthesiology, Tri-Service General Hospital, National Defense Medical Center, 325, Cheng-gong Road Section 2, Neihu, Taipei 11490, Taiwan. mkjsheen@ndmctsgh.edu.tw

Publication date & source: 2008-11, Br J Anaesth., 101(5):711-5. Epub 2008 Aug 18.

Publication type: Research Support, Non-U.S. Gov't

BACKGROUND: Activation of the serotonergic system is an important factor in the pathogenesis of intrathecal morphine-induced pruritus. Mirtazapine is a new antidepressant that selectively blocks 5-HT(2) and 5-HT(3) receptors. We therefore tested the hypothesis that preoperative mirtazapine would reduce the incidence of intrathecal morphine-induced pruritus. METHODS: One hundred and ten ASA I patients undergoing lower limb surgery under spinal anaesthesia were randomly allocated into two equal groups and received either mirtazapine 30 mg or an orally disintegrating placebo tablet 1 h before operation in a prospective, double-blinded trial. All patients received an intrathecal injection of 15 mg of 0.5% isobaric bupivacaine and 0.2 mg preservative-free morphine. The occurrence and the severity of pruritus were assessed at 3, 6, 9, 12, and 24 h after intrathecal morphine. RESULTS: Pruritus was significantly more frequent in the placebo group compared with the mirtazapine group (75% vs 52%, respectively; P=0.0245). The time to onset of pruritus in the two groups was also significantly different. The patients who experienced pruritus in the placebo group had a faster onset time than that in the mirtazapine group [mean (sd): 3.2 (0.8) vs 7.2 (4.1) h, P<0.0001]. CONCLUSIONS: Mirtazapine premedication prevents pruritus induced by intrathecal morphine in patients undergoing lower limb surgery with spinal anaesthesia.