Prophylactic mirtazapine reduces intrathecal morphine-induced pruritus

M. J. Sheen, S. T. Ho, C. H. Lee, Y. C. Tsung, F. L. Chang, S. T. Huang

Research output: Contribution to journalArticlepeer-review

30 Citations (Scopus)


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-HT2 and 5-HT3 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.

Original languageEnglish
Pages (from-to)711-715
Number of pages5
JournalBritish Journal of Anaesthesia
Issue number5
Publication statusPublished - Nov 2008
Externally publishedYes


  • Anaesthetic techniques, subarachnoid
  • Analgesics opioid, morphine
  • Complications, pruritus
  • Pharmacology, mirtazapine

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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