Primer of Postoperative Pruritus for Anesthesiologists

Waxler, Beverly; Dadabhoy, Zerin P.; Stojiljković, Ljuba; Rabito, Sara F.

doi:10.1097/00000542-200507000-00025

Cited by 64 publications

(62 citation statements)

References 120 publications

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“…Currently, the mechanism underlying morphine-related pruritus remains uncertain, but morphine-induced pruritus is considered mediated by the l-opioid receptors 31 and the j-opioid receptors. 32,33 Accordingly, administration of butorphanol (a partial l-opioid receptor antagonist and j-opioid receptor agonist) with morphine (l-and j-receptor agonist) would be expected to maintain analgesia (l-and j-receptors) while reducing pruritus.…”

Section: Discussionmentioning

confidence: 99%

Butorphanol prevents morphine-induced pruritus without increasing pain and other side effects: a systematic review of randomized controlled trials

Song

Wang

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Pruritus is a frequent adverse event after administration of morphine. Butorphanol has been used to prevent morphine-induced pruritus, but its efficacy is still controversial. The aim of this systematic review was to evaluate the efficacy of using butorphanol to prevent morphine-induced pruritus. Source We searched PubMed, Cochrane Library, EMBASE, and China's BioMedical Disc for full reports of randomized controlled trials that compared the use of butorphanol with either placebo or no treatment for preventing morphineinduced pruritus. The number of patients experiencing pruritus or other side effects was analyzed using relative risk (RR) with 95% confidence intervals (CI). Principal findings Sixteen trials (795 patients) were analyzed. Continuous intravenous and epidural butorphanol reduced pruritus with RR 0.22 (95% CI 0.10 to 0.45) and RR 0.24 (95% CI 0.16 to 0.36), respectively. Use of epidural butorphanol decreased the number of patients requesting rescue treatment for pruritus (RR 0.57; 95% CI 0.41 to 0.81). Butorphanol decreased postoperative pain intensity at four, eight, and 12 hr with standardized mean differences of -0.29 (95% CI -0.52 to -0.05), -0.30 (95% CI -0.56 to -0.04), and -0.23 (95% CI -0.46 to -0.01), respectively. Epidural but not intravenous butorphanol reduced postoperative nausea and vomiting (PONV) (RR 0.35; 95% CI 0.19 to 0.66). Butorphanol did not increase respiratory depression (RR 0.71; 95% CI 0.31 to 1.63), somnolence (RR 0.71; 95% CI 0.22 to 2.37), or dizziness (RR 2.45; 95% CI 0.35 to 17.14). Conclusion Butorphanol administered with morphine may be an effective strategy for preventing morphineinduced pruritus as it decreases pain intensity and PONV without increasing other side effects. Thus, it can be recommended for preventing morphine-induced pruritus during the perioperative period. RésuméObjectif Le prurit est un effet secondaire néfaste fréquent après l'administration de morphine. Le butorphanol a été utilisé pour prévenir le prurit induit par la morphine, mais son efficacité est encore controversée. L'objectif de cette revue méthodique était d'évaluer l'efficacité du butorphanol pour prévenir le prurit induit par la morphine.

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Section: Discussionmentioning

confidence: 99%

Butorphanol prevents morphine-induced pruritus without increasing pain and other side effects: a systematic review of randomized controlled trials

Song

Wang

et al. 2013

Can J Anesth/J Can Anesth

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“…administration of opioids is one of the most frequently used methods of analgesia in humans (Dougherty and Staats, 1999;Bennett et al, 2000;Rathmell et al, 2005), it is important to study further the functions of spinal NOP receptors in a primate species. Administration of -opioid receptor agonists by the spinal route has become a more popular approach to treatment of pain during the last 2 decades; however, the most common side effect of spinal morphine administration is pruritus (itch sensation), which sometimes is severe and lessens the value of spinal opioids for pain relief (Cousins and Mather, 1984;Waxler et al, 2005). Recent studies have demonstrated that the same -opioid receptors mediate i.t.…”

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confidence: 99%

Effects of Intrathecally Administered Nociceptin/Orphanin FQ in Monkeys: Behavioral and Mass Spectrometric Studies

Ko¹,

Wei²,

Woods³

et al. 2006

J Pharmacol Exp Ther

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Nociceptin/orphanin FQ (N/OFQ) is a heptadecapeptide that is an endogenous ligand for the N/OFQ peptide (NOP) receptor. The aim of this study was to investigate the behavioral responses of N/OFQ and its major fragment N/OFQ(2-17) in monkeys following i.t. administration. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was used to quantify the amounts of N/OFQ and N/OFQ(2-17) in the cerebrospinal fluid at specific time points when effects of i.t. N/OFQ were sustained and disappeared. Intrathecal administration of N/OFQ dose dependently (10 -100 nmol) produced long-lasting antinociception against a noxious stimulus, 50°C water, and did not elicit itch/scratching responses in monkeys. Subcutaneous pretreatment with a selective NOP receptor antagonist, (ϩ)J-113397 [(1-[3R,4R)-1-cyclooctymethyl-3-hydroxymethyl-4-piperidyl]-3-ethyl-1,3,-dihydro-2H-benzimidazol-2-one] (0.1 mg/kg), completely blocked i.t. N/OFQ (100 nmol)-induced antinociception. In contrast, a classic opioid receptor antagonist, naltrexone (0.01 and 1 mg/kg), failed to reverse i.t. N/OFQ-induced antinociception. MALDI-TOF-MS showed that the amount of N/OFQ(2-17) was 4-fold higher than that of N/OFQ at 1.5 h after i.t. administration of 100 nmol N/OFQ. Intrathecal N/OFQ-induced antinociception disappeared at 4.5 h, which corresponded to nearly undetectable cerebrospinal fluid levels of N/OFQ. No other metabolite of N/OFQ was detected at appreciable levels at either the 1.5-or 4.5-h time points. Although significant amounts of N/OFQ(2-17) were detected at the 1.5-and 4.5-h time points, 100 nmol N/OFQ(2-17) i.t. was inactive in changing the monkeys' nociceptive threshold. These results provide the first functional evidence of spinal N/OFQ-induced antinociception in primates and indicate that activation of spinal NOP receptors may be a potential target for spinal analgesics.The orphan opioid receptor has been identified in several species. It was previously called the ORL1 receptor and is now named the NOP receptor, as the fourth member within the opioid receptor family, by the International Union of Pharmacology (Mollereau et al., 1994;Foord et al., 2005). The sequence of the NOP receptor is closely related to each of the classical, well characterized -, ␦-, and -opioid receptors. However, ligands that bind to these classic opioid receptors do not bind NOP receptors with high affinity (Mollereau et al., 1994). The NOP receptor is widely distributed in the central nervous system, and it may participate in a broad range of behavioral and physiological functions (Neal et al., 1999a,b). Nociceptin/orphanin FQ (N/OFQ), an endogenous peptide at the NOP receptor, inhibits cyclic AMP accumulation and Ca 2ϩ currents and increases K ϩ conductance in neurons, similar to the effects of agonists at the other opioid receptors (Meunier et al., 1995;Reinscheid et al., 1995;Jennings, 2001). These in vitro studies seem to support an inhibitory function of NOP receptor activation at sensory neurons (Stanfa et al., 1996;Hel...

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“…5,13,24 The primary neurons (histamine-sensitive and mechano-insensitive) synapse via dorsal root ganglia with second-order neurons in the dorsal horn of the spinal cord. 2,5,11,19,24 Unlike pain, itch does not provoke a spinal reflex. 25 The secondary neurons cross over to join the contralateral spinothalamic tract (STT) and ascend to the thalamus, where they synapse with third-order neurons for transmission to the somatosensory cortex of the postcentral cingulate gyrus.…”

Section: Theoretical Framework For Itchmentioning

confidence: 99%

“…25 The secondary neurons cross over to join the contralateral spinothalamic tract (STT) and ascend to the thalamus, where they synapse with third-order neurons for transmission to the somatosensory cortex of the postcentral cingulate gyrus. 11,19,25 The C-fibers are sensitive to histamine, growth factors, and other pruritogens, which may be present in open wounds. 5,19,25,26 Sun and Chen 27 examined thermal, mechanical, inflammatory, and neuropathic pain responses in gastrin-releasing peptide receptor (GRPR)-mutant mice and found that there was no difference in responses when compared to responses of unaltered wild-mice to noxious stimuli.…”

Section: Theoretical Framework For Itchmentioning

confidence: 99%

“…While pruritus has been specified as itch without a particular cause or without apparent skin changes, itch is synonymous with pruritus. 5,[10][11][12] Pruritus is generally considered a sensation of the skin, but wound pruritus is related to wounds, which are often through the skin and deeper than the skin. 5 Wound itch or wound pruritus is "the irritating sensation or disturbing feeling related to an open wound, including the wound bed and the skin immediately surrounding the open wound".…”

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Wound pruritus: pathophysiology and management

Paul

2015

CWCMR

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Purpose: The objective of this article is to review literature on wound pruritus, with a focus on summarizing pathophysiology and management. Method: Literature related to the physiology of itch was reviewed. PubMed, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase were searched for all research studies written in English which include "wound" (injury/burn) and "pruritus" (itch) in the title or abstract. Articles were accepted if they involved wounds or acute burns. Literature related to options for management of wound pruritus was reviewed. Results: While all types of wounds can be the source of associated pruritus, most studies have been done concerning pruritus associated with burns. There are treatment options for pruritus which can be considered for management of wound pruritus. Conclusion: Further research is indicated to gain insights into the problem of wound pruritus. As more is learned about the physiology of wound pruritus, more effective management strategies can be developed and employed.

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Primer of Postoperative Pruritus for Anesthesiologists

Cited by 64 publications

References 120 publications

Butorphanol prevents morphine-induced pruritus without increasing pain and other side effects: a systematic review of randomized controlled trials

Butorphanol prevents morphine-induced pruritus without increasing pain and other side effects: a systematic review of randomized controlled trials

Effects of Intrathecally Administered Nociceptin/Orphanin FQ in Monkeys: Behavioral and Mass Spectrometric Studies

Wound pruritus: pathophysiology and management

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