Pruritus after intrathecal morphine for cesarean delivery: incidence, severity and its relation to serum serotonin level

Aly, Mahmoud; Ibrahim, Ahmed; Farrag, Waleed Saleh; Abd-Elsalam, Kelani Ali; Mohamed, Heba Kamal; Tawfik, Azza A.

doi:10.1016/j.ijoa.2018.02.004

Cited by 14 publications

(6 citation statements)

References 22 publications

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“…Notwithstanding of this, serotonin is defined as a pruritogen because cutaneous injection with serotonin successfully elicits itch in healthy humans and mice (Akiyama et al, 2010;Weisshaar et al, 1997). Indeed, serotonin signaling is not only associated with itchy skin disorders such as AD (Huang et al, 2004), allergic contact dermatitis (Liu et al, 2013;Lundeberg et al, 1999), and psoriasis (Nordlind et al, 2006), but has also been linked to itch caused by systemic conditions like cholestasis, uremia, and morphine-induced pruritus (Aly et al, 2018;Kerr et al, 1992;Schwö rer et al, 1995). However, the precise and robust manner in which serotonin can be effectively manipulated to treat chronic itch disorders in patients remains to be shown.…”

Section: Biogenic Aminesmentioning

confidence: 99%

The Return of the Mast Cell: New Roles in Neuroimmune Itch Biology

Wang

Yang

Kim

2020

Journal of Investigative Dermatology

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The mast cellenerve unit classically has represented a fundamental neuroimmune axis in the development of itch because of the traditional prominence of histamine as a pruritogen. However, it is appreciated increasingly that most chronic itch disorders are likely nonhistaminergic in nature, provoking the hypothesis that other novel effector itch mechanisms derived from mast cells are important. In this review, we present an overview of classical mast cell biology and put these concepts into the context of recent advances in our understanding of the regulation and function of the mast cellenerve unit in itch biology.

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Section: Biogenic Aminesmentioning

confidence: 99%

The Return of the Mast Cell: New Roles in Neuroimmune Itch Biology

Wang

Yang

Kim

2020

Journal of Investigative Dermatology

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“…Also, Pettini et al (12) and Tan et al (13) reported a history of allergies is a potential risk factor for pruritus caused by morphine. Studies by Pettini et al (12) and Aly et al (14) have shown that serum serotonin levels are significantly increased in patients after cesarean section, and the absence of serotonin receptor antagonists is also a potential risk factor for pruritus.…”

Section: Discussionmentioning

confidence: 99%

Rashes following cesarean delivery: a case report

et al. 2020

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This work reports a case of rashes on multiple parts of the body following cesarean delivery caused by routine use of cefuroxime sodium and morphine during the perioperative period. A 29-yearold woman underwent a lower segment cesarean section under combined spinal-epidural anesthesia.During surgery, cefuroxime sodium was administered intravenously following the division of the umbilical cord for the prevention of infection. Morphine hydrochloride was given for analgesia at the end of the procedure. Rashes and pruritus appeared on the patient's abdomen, back and thighs. Cephalosporins and opioids may cause rashes and pruritus. According to the patient's physical signs and the time of drug injection, we considered the rash and pruritus adverse reactions caused by cefuroxime sodium and morphine hydrochloride. After the discontinuation of the medications, antiallergic treatment and the other treatment of symptoms, the patient's symptoms gradually subsided. To this end, we speculate that cefuroxime sodium or morphine hydrochloride cause adverse reactions, including rashes in patients. Physicians, nurses, and clinical pharmacists should closely observe patients who receive these medications. The medications should be at once stopped if an adverse reaction occurs.

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“… 35 , 36 A recent study showing a dose-dependent increase of serum serotonin and pruritus after intrathecal injection of morphine supports the hypothesis that the serotonergic pathway is essential in intrathecal morphine-induced pruritus. 42 …”

Section: Discussionmentioning

confidence: 99%

Prevention and Treatment of Neuraxial Morphine-Induced Pruritus: A Scoping Review

Becker¹,

Teunissen²,

Koopman³

2022

JPR

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The addition of morphine to neuraxial anaesthesia leads to improved postoperative analgesia and lower opioid consumption, but is often accompanied by pruritus. Studies on preventing or treating pruritus show contradictory results. Our objective was to identify effective drugs for the prevention or treatment of pruritus by a scoping review of clinical trials. A systematic literature search was conducted in PubMed, Embase and Web of Science. We identified clinical trials investigating the prevention or treatment of neuraxial morphine-induced pruritus in adults. Systematic reviews and meta-analyses were screened for eligible studies. One-hundred-and-four articles were included covering 13 pharmacological groups. We conclude that dopamine antagonists, µ-opioid agonist/antagonists and neuraxial or orally administered µ-opioid antagonists prevent pruritus caused by neuraxial morphine regardless of the timing of administration. In the reviewed literature, 5HT3-antagonists prevent neuraxial morphine-induced pruritus when administered before morphine administration. For the treatment of neuraxial morphine-induced pruritus, only nalbuphine appears to be consistently effective. More research is needed to find the most effective doses and the optimal timing of the effective medication.

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Pruritus after intrathecal morphine for cesarean delivery: incidence, severity and its relation to serum serotonin level

Cited by 14 publications

References 22 publications

The Return of the Mast Cell: New Roles in Neuroimmune Itch Biology

The Return of the Mast Cell: New Roles in Neuroimmune Itch Biology

Rashes following cesarean delivery: a case report

Prevention and Treatment of Neuraxial Morphine-Induced Pruritus: A Scoping Review

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