Comparative study between nalbuphine and dexamethasone for prevention of epidural morphine-induced pruritus in lower abdominal surgery

Background Epidural morphine is an effective analgesic technique for lower abdominal surgery, butpruritus is its most common side effect. Nalbuphine is an agonist–antagonist opioid and effective in treating opioid-induced pruritus. Dexamethasone is a corticosteroid with anti-inflammatory and antiallergic properties. We compared the effectiveness of intramuscular dexamethasone and nalbuphine in the prevention of epidural morphine-induced pruritus after lower abdominal surgery.Methods One hundred and fifty, American Society of Anesthesiologists physical status I or II, patients undergoing lower abdominal surgery with epidural anesthesia were assigned randomly to three groups. Group A, group B, and group C received intramuscular normal saline (2 ml; n = 50), dexamethasone (8 mg/2 ml; n = 50), and nalbuphine (10 mg/2 ml; n =50), respectively, after skin closure. The occurrence and severity of pruritus were assessed at 1, 4, 8, and 12 h after surgery.Results Pruritus occurred less frequently in group C than group B (P 0.05). At 4, 8 and 12 hpostoperatively, the severity of pruritus was significantly different (P 0.05) and was significantly less in group C than group B in the intergroup comparison (P 0.05). Conclusion Nalbuphine proved to be better than dexamethasone in the prevention of epidural morphine-induced pruritus in patients who underwent lower abdominal surgery. Prophylactic intramuscular nalbuphine (10 mg) is effective in decreasing the incidence and severity of pruritus and does not affect analgesia.