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Should epidural diamorphine be withheld after caesarean section from women who suffer severe pruritus following intrathecal fentanyl?

Pruritus following neuraxial opioids in 37 women undergoing caesarean section under combined epidural-spinal anaesthesia was investigated. All women received intrathecal fentanyl for intra-operative analgesia followed by epidural diamorphine for postoperative analgesia, when pain returned. Pruritus was assessed using a verbal rating scale at the end of surgery and again 24-36 h postoperatively. There was no relationship between pruritus experienced after intrathecal fentanyl and that experienced after epidural diamorphine. We conclude that there is no reason to withhold epidural diamorphine from women who have previously experienced severe itching after intrathecal fentanyl.