Neuraxial opioid-induced pruritus: a review.
When intrathecal and epidural opioids are administered, pruritus occurs as an unwanted and troublesome side effect. The reported incidence varies between 30% and 100%. The exact mechanisms of neuraxial opioid-induced pruritus remain unclear. Postulated mechanisms include the presence of an "itch center" in the central nervous system, medullary dorsal horn activation, and antagonism of inhibitory transmitters. The treatment of intrathecal opioid-induced pruritus remains a challenge. Many pharmacological therapies, including antihistamines, 5-HT(3)-receptor antagonists, opiate-antagonists, propofol, nonsteroid antiinflammatory drugs, and droperidol, have been studied. In this review, we will summarize pathophysiological and pharmacological advances that will improve understanding and ultimately the management of this troublesome problem.
Szarvas
Szilvia
S
Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Wilton Road, Cork, Ireland. szarvasszilvia@hotmail.com
Harmon
Dominic
D
Murphy
Damian
D
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D006801:Humans; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009407:Nerve Block / Q000009:adverse effects*; D011537:Pruritus / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology; D012702:Serotonin Antagonists / Q000627:therapeutic use
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009292:Narcotic Antagonists; D012702:Serotonin Antagonists