الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
The use of intrathecal morphine as an adjuvant to local anesthetics is of no doubt offers a sustained analgesic effect.Unfortunately, intrathecal morphine is not devoid of side effects such as itching, nausea, vomiting, respiratory depression, urinary retention, and constipation.
I.V naloxone decreases incidence and severity of the common morphine side effects (pruritis, nausea/emesis, constipation, urinary retention, respiratory depression and undesirable sedation) .The addition of naloxone to intrathecal morphine decreases the opioid related side effects without affection of postoperative analgesia.
The aim of our study was the investigatation of the effect of adding ultra small dose of naloxone to intrathecal morphine on morphine related side effects and on quality of postoperative analgesia in patients undergoing minor anal surgeries.
Methods :
All the patients were randomly assigned to one of the two groups;
group B [ n=50 patients] : each one has received intrathecal injection of 5 mg of 0.5% hyperbaric bupivacaine with 0.2 mg morphine in 0.5 ml volume, plus 0.5 ml normal saline as placebo [total volume 2 mL].
group L [n=50 patients] each participant has received 5 mg of 0.5% hyperbaric bupivacaine with 0.2 mg morphine in 0.5 ml volume, plus 5ng/kg naloxone in 0.5 ml volume [total volume 2 mL].
Demographic data (age, gender , weight and height ) were recorded.The time passed from the successful sensory block [S4 block] until regression of such block, the onset of first rescue analgesia [VAS ≥3], Modified Bromage scale after block, and time for its regression were recorded.
Vital data including; heart rate [HR], mean arterial blood pressure [MAP], oxygen saturation [SpO2], and respiratory rate [RR] all were recorded before procedure [basal values], then every 15 min. for 2 h. after subarachnoid block. The same data were collected during the postoperative period in the 2nd,4th,6th,12th,18th, and 24th hours. Pain and itching scores were recorded along with postoperative nausea and or vomiting [PONV] assessment system every two hours during the first post-operative day. PONV and their severity were collected face to face using a numerical scale based upon Edmonton Symptom Assessment System with a numerical scale rating scale from 0 to 10; 0–2 [mild], 3–6 [moderate], 7–10 [intense], and the patient himself selected the number associated with the symptom severity. Pruritus was assessed in a similar way by VAS scale as following: the patient selected the scale that best representing the severity of his itching [No=itching and 10=Worst possible itching].
Results:
No rescue analgesia was required by any of participants, with VAS values equal zero during the whole follow-up period in both groups. Scores of PONV were lower in group L than group B with significant differences at the early 10 postoperative hours in addition to the 16th hour . Itching scores were generally lower in group L than group B, with significant differences at the 2nd and 4th post-operative hours .
There were significant differences between both groups regarding the percentages of patients who suffered from PONV, pruritus, and mixed PONV with pruritus. group B has higher ratios of such complications. No other complications have been recorded in our patients during the study period.
Conclusion :
Our study shows that the addition of ultrasmall dose of naloxone to intrathecal morphine in patients undergoing minor anal surgeries receiving spinal anesthesia reduces the side effects of morphine (nausea , vomiting and itching ). This addition doesnꞌt reduce the analgesic effect of morphine .