jurnal indra pruritus

8/19/2019 Jurnal Indra Pruritus

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Indrati Tyas Siwi TR


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BACKGROUNDGenetic polymorphism (A!G" in the m#opioid

receptor has $een reported to a%ect systemicopioid anal&esia' owe)er* reportedpharmaco&enetic e%ects on spinal opioidanal&esia* partic+larly in la$o+r* ha)e $eene,+i)ocal'


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-.TODS/e prospecti)ely assessed e%ects o0 the m#opioid

receptor A!G sin&le n+cleotide polymorphism(SN1" on anal&esia a0ter 23 m& o0 spinal 0entanyl'

/e st+died two ethnically distinct hospital pop+lations(-iami and 4er+salem"'

Independent )aria$les were A!G* ethnicity* andhospital'

1rimary o+tcome was time 0rom spinal anal&esia +ntilanal&esic re,+est'

Secondary o+tcomes were pain and pr+rit+s* assessedat repeated inter)als +ntil anal&esia re,+est'


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SUBJECTS

1atients were eli&i$le i0 they were n+lliparo+s* a&e !563* in early la$o+r (cer)ical dilatation 257 cm"* ASA

stat+s I5II* $ody wei&ht 8 3 9&* &estational a&e ':; wee9s* with a sin&leton pre&nancy in )erte<presentation'

1atients were e


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Spinal analgesia

Com$ined spinal epid+ral (CS." anal&esia was per0ormed+sin& an !G T+ohy epid+ral at what was ass+med to $ethe =:>6 or =6>7 interspace +sin& loss o0 resistance to air inthe sittin& position with the needle thro+&h needletechni,+e' A 2;G atra+matic spinal needle was inserted

past the tip o0 the T+ohy needle +ntil it was 0elt to pass thed+ra'

Intrathecal placement was con?rmed $y @ow o0 cere$rospinal@+id (CS" either spontaneo+sly or on aspiration into a 2 mlsyrin&e' entanyl 23 m& was administered intrathecallywith no local anaesthetic or ad+)ant dr+& +sin& a mlsyrin&e 0ollowed $y ml o0 preser)ati)e#0ree saline* $y slowinection more than 7 s' A G epid+ral catheter was then

inserted :57 cm into the epid+ral space'


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MEASUREMENTContin+o+s data were recorded d+rin& pea9 +terine

contraction at the 0ollowin& time points (i" the threecontractions $e0ore spinal anal&esia* (ii" the ?rst ?)e

contractions a0ter spinal anal&esia* (iii" the ?rstcontraction that 0ollowed each s+$se,+ent 7 mininter)al* and (i)" the ?rst re,+est 0or additionalanal&esia'

A0ter ?rst anal&esic re,+est* all s+$ects recei)edincremental epid+ral doses o0 $+pi)acaine 3'E with 2m& ml2 0entanyl to achie)e anal&esia* and were thentreated with epid+ral 1CA +sin& the same sol+tion'


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GENOTYPING

Feno+s $lood (7 ml" was sampled at the time o0enrolment' DNA was e


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STATISTICAL ANALYSIS

The primary end point was the time 0rom spinal0entanyl to ?rst re,+est 0or additional anal&esia'Secondary end points were FA1S* pr+rit+s*na+sea* and -A1' /e assessed the e%ects o0 the0ollowin& independent )aria$les A!G (AA orAG>GG"* ethnic &ro+p and hospital (-iami or

4er+salem"' Data are presented as mean (SD" orco+nts (E" where appropriate' Data wereassessed 0or normal distri$+tion'


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R.SU=TSOne h+ndred and twenty#?)e n+lliparo+s part+rients in early

la$o+r were analysed' The allelic 0re,+ency o0 A!G was6'!E (6'6E in -iamiH 7'7E in 4er+salem"' Time toanal&esia re,+est (SD" in -iami was 22 (66" min and in

4er+salem was ! (:2" min* 1*3'33H ispanic 2: (6;" min )s 4ew>Ara$ ! (:2" min* 1*3'33H Blac9 2 (6" min)s4ew>Ara$ ! (:2" min* 1J3'37'

There was no si&ni?cant e%ect o0 A!G' S+r)i)al analysisshowed -iami ' 4er+salem* 1*3'33H ispanics and Blac9 '

4ew>Ara$* 1*3'33Hno e%ect o0 A!G' /ithin hospital &ro+ps*A!G had no e%ect on time to anal&esic re,+estH within&enomic &ro+ps there was a si&ni?cant di%erence $etweenhospitals' The time#co+rse 0or pr+rit+s e


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CONC=USIONS/e 0o+nd no si&ni?cant e%ect 0or the A!G

sin&le n+cleotide polymorphism (SN1" onanal&esic d+ration a0ter spinal 0entanyl 0orla$o+r'

In contrast* ethnically distinct hospitalpop+lation &ro+ps e


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DISCUSSION

Se)eral 0actors mi&ht e


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-+lti0actorial nat+re o0 la$o+r painm+ltiplematernal50etal and o$stetricmana&ement 0actors a%ect the se)erity o0

la$o+r pain* incl+din& parity* sta&e o0 la$o+r*pro&ress in la$o+r* o


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Inade,+ate power to identi0y pharmaco&eneticdi%erences there are +ni,+e considerationswhen per0ormin& sample sie calc+lations 0or&ene association st+dies'


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The marke e!e"# $% e#hni"all& is#in"#h$spi#al p$p'la#i$ns

All &ro+ps had similar onset o0 anal&esia andpr+rit+s a0ter spinal 0entanyl* $+t the d+ration o0$oth was mar9edly shorter in the hospital

pop+lation in 4er+salem compared with -iami'.thnicity and hospital location were co#linear

)aria$les' As all the ispanic and Blac9 s+$ectswere in -iami* and all the 4ewish and Ara$

s+$ects were in 4er+salem* it is not possi$le toassess 0rom these data whether the di%erencesare attri$+ta$le to ethnicity or to some otherca+se associated with local hospital pop+lationor practice


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Care was ta9en to +se the same spinal needleand 0ollow identical st+dy protocols in $othhospitals*and the same in)esti&ator .'-'D'directly s+per)ised s+$ect enrolment* spinal0entanyl administration and data

.thnicity has $een identi?ed as a 0actor in theperception o0 pain and co+ld ha)e contri$+tedto the di%erent reported rates o0 re,+est 0orla$o+r anal&esia in di%erent ethnicpop+lations'


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ANALGESIA AND PRURITUS

1r+rit+s is a well#reco&nied side#e%ect that characteriesspinal opioid anal&esia' /e demonstrated identical time

co+rses 0or the onset and o%set o0 $oth pr+rit+s andanal&esia' Similarly* we demonstrated identical e%ectso0 independent )aria$les (&enomic &ro+p andethnic>hospital pop+lation" on the onset and o%set o0pr+rit+s and anal&esia'

O+r con?dence in the a0orementioned $etween#&ro+pe%ects on 0entanyl#ind+ced anal&esia is stren&thened

$y identical $etween#&ro+p e%ects on 0entanyl#ind+cedpr+rit+s'


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SUMMARY ollowin& spinal 0entanyl administration* we

o$ser)ed that ethnically distinct hospitalpop+lation &ro+ps e


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TANK OU

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