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• W1575519034 abstract "I read with interest the correspondence (Ng & Plaat. Anaesthesia 2003; 58: 399–400), which describes the anaesthetic management of a parturient with recurrent scabies infection presenting for elective Caesarean section. I have to agree with the authors that despite the worldwide prevalence of this ectoparasitic skin disease, no other reports addressing the anaesthetic implications and safety of regional anaesthesia in patients with active Sarcoptes scabiei infestation can be found in the literature. The diagnosis of scabies is essentially clinical [1]. Patients typically present with a history of recurrent pruritus with scratch marks in suggestive areas (interdigital folds, cubital margins of the hands, anterior face of the wrists, anterior axillae, around the navel and nipples, external genitalia, and the anterointernal aspect of the thighs), most often associated with specific signs (burrow, pearl-like vesicular eruptions and scabious nodules). The diagnosis is microscopically confirmed when skin scrapings of external burrows or papule material reveal mites, ova or faecal pellets [2]. In primary infestations, the incubation time is 15–20 days, but may sometimes be longer than 6 weeks. Therefore, initial infestation may be relatively asymptomatic, and without suggestive skin lesions for the first 2–6 weeks. Ectoparasitic skin infestation with Sarcoptes scabiei remains a common cause of skin rash and pruritus worldwide. However, pruritus is also the most common side-effect of subarachnoid and/or epidural opioid administration [3]. Pruritus follows subarachnoid opioid administration more often in obstetric patients than in any other patient group, with the incidence ranging from 40 to 80% of parturients treated with subarachnoid opioids. Opioid-induced pruritus is typically mild and involves the face and/or chest (breast) area. Occasionally, the intensity of itching is so annoying that it interferes with sleep and breast-feeding. The aetiology of opioid-related pruritus is unclear. To date, no reports have specifically addressed the coexistence and/or the differential diagnosis between the scabies-related and subarachnoid opioid-related pruritus in a parturient. In my practice of obstetric anaesthesia, I encountered a parturient whose first lifetime diagnosis of primary scabies infection was brought about by the differential diagnosis of persistent peripartum itching initially solely attributed to subarachnoid opioid administration for labour analgesia (unpublished data). An otherwise healthy 29-year-old pregnant woman at 39 weeks gestation was in labour (with painful uterine contractions) and consented to a combined spinal-epidural analgesia (CSEA), which was performed in a standard manner with an 18-gauge Tuohy-Schliff epidural needle and a 27-gauge Whitacre spinal needle. Following the appearance of CSF at the hub of the spinal needle, 5 µg of fentanyl combined with 2.0 mg of ropivacaine (1 ml of 0.2% solution) was injected into the subarachnoid space. A 20-gauge multiorifice epidural catheter was inserted 5 cm into the epidural space. Aspiration from the epidural catheter was negative for blood and CSF. The patient reported pain relief approximately 2 min after the subarachnoid injection. However, approximately 10 min later, she reported onset of moderate to severe pruritus involving the chest (breasts), mid abdomen, lower back, anterolateral thighs, perineum and the buttocks. Interestingly, the patient reported no facial (perioral) pruritus. Treatment with subhypnotic doses of intravenous propofol (10 mg) and small doses of intravenous naloxone (0.08 mg) provided no relief of pruritus, which continued throughout the course of her labour, the uneventful vaginal delivery and into the postpartum period. Consultation with the dermatologist, aided by the microscopic skin scraping examination, established the diagnosis of primary scabies infection and the patient admitted to recent (6 weeks prior) travel to rural regions in South America. In conclusion, it is difficult to speculate if the onset of scabies-related pruritus in our patient (which seemed to have been triggered by subarachnoid opioid administration) would have been significantly delayed had the patient not received subarachnoid opioids for labour analgesia. It is also possible that initially the coexistence of opioid-induced and scabies-induced pruritus was responsible for our patient's symptoms." @default.
• W1575519034 created "2016-06-24" @default.
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• W1575519034 date "2003-10-20" @default.
• W1575519034 modified "2023-09-24" @default.
• W1575519034 title "Scabies: a differential diagnosis of pruritus following subarachnoid opioid administration" @default.
• W1575519034 cites W1969495872 @default.
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• W1575519034 doi "https://doi.org/10.1046/j.1365-2044.2003.03510.x" @default.
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