Pruritus—itching for a cause and relief?

Kam, P. C. A.; Tan, K. H.

doi:10.1111/j.1365-2044.1996.tb15050.x

Cited by 67 publications

(44 citation statements)

References 48 publications

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“…Postoperative itching after IT narcotics is an undesirable side effect of anesthesia and is caused by several, complex mechanisms. 2,3,5 Current research indicates that central causes of pruritus are more important than peripheral ones. 2 IT opioid-induced itching may be related to the cephalad spread of the drug in the cerebrospinal fluid and its action on both µ receptors (in the medulla), 5,9,10 and central serotonin type 3 receptors (in the spinal cord and medulla).…”

Section: R Re Es Su Ul Lt Ts Smentioning

confidence: 99%

“…2,3,5 Current research indicates that central causes of pruritus are more important than peripheral ones. 2 IT opioid-induced itching may be related to the cephalad spread of the drug in the cerebrospinal fluid and its action on both µ receptors (in the medulla), 5,9,10 and central serotonin type 3 receptors (in the spinal cord and medulla). 11,12 Therefore, opioids that do not cause peripheral histamine release can still cause itching.…”

Section: R Re Es Su Ul Lt Ts Smentioning

confidence: 99%

“…Itching after intrathecal (IT) opioids is an undesirable side effect of opioids [1][2][3] which can develop with a frequency ranging between 20 and 80%. 2,4 The mechanisms causing pruritus (and the resultant scratching) are complex 2,3,5 and may involve central or peripheral mechanisms. Central mechanisms of opioid-induced pruritus (either systemically or regionally) are more important clinically than peripheral mechanisms.…”

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confidence: 99%

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L’administration prophylactique d’ondansétron ne réduit pas l’incidence de prurit induit par le sufentanil intrathécal

Waxler

Mondragon

Patel

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Postoperative itching after intrathecal (IT) narcotics may be a difficult and important problem for both the anesthesiologist and the patient in the postanesthetic care unit. Since some studies have reported success in preventing itching with ondansetron, we designed a prospective, randomized, double-blinded, and controlled study to test whether prophylactic iv ondansetron effectively reduces the incidence of IT sufentanil-induced pruritus.M Me et th ho od ds s: : Thirty-four patients (ASA I-III, age 18-74 yr) underwent ambulatory surgery after spinal anesthesia with IT lidocaine (15-100 mg) and IT sufentanil (10 µg). The patients were randomized into two groups to receive iv either 4 mL saline (n = 13) or 8 mg ondansetron (n = 21) before the IT injection. The incidence of pruritus and other variables was recorded. Pruritus scores were obtained with a verbal analogue score with 0 meaning none and 10 the worst itching that the patient could imagine. Statistical difference was assumed if P < 0.05. R Re es su ul lt ts s: : Ondansetron did not reduce the incidence of pruritus (77 vs 81%) compared to placebo (P = 1.000). The pruritus scores (4.4 vs 3.6) of the two groups were not significantly different (P = 0.670).C Co on nc cl lu us si io on ns s: : There are contradictory findings in the literature regarding the effectiveness of ondansetron in preventing narcoticinduced itching. Although some studies have indicated that ondansetron could prevent this side effect of IT narcotics, a recent report suggested that ondansetron is not effective in preventing narcotic-induced itching (sufentanil-morphine) after a Cesarean section. In the present study we obtained similar, negative results. Objectif : Le prurit postopératoire induit par l'administration intrathé-cale (IT) de narcotiques est un problème important pour l'anesthésio-logiste et le patient en salle de réveil. Certaines études ont montré que l'ondansétron prévenait le prurit. Notre étude prospective, randomisée, contrôlée et à double insu voulait vérifier si l'administration iv préventive d'ondansétron réduit effectivement l'incidence de prurit induit par le sufentanil IT. Méthode : Trente-quatre patients (ASA I-III, de 18 à 74 ans) ont subi une intervention chirurgicale ambulatoire sous rachianesthésie avec de la lidocaïne IT (15-100 mg) et du sufentanil IT (10 µg). Les patients, randomisée en deux groupes, ont reçu soit 4 mL de solution saline iv (n = 13), soit 8 mg d'ondansétron (n = 21) avant l'injection IT. L'incidence de prurit et d'autres variables a été notée. Les scores de

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Section: R Re Es Su Ul Lt Ts Smentioning

confidence: 99%

Section: R Re Es Su Ul Lt Ts Smentioning

confidence: 99%

mentioning

confidence: 99%

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L’administration prophylactique d’ondansétron ne réduit pas l’incidence de prurit induit par le sufentanil intrathécal

Waxler

Mondragon

Patel

et al. 2004

Can J Anesth/J Can Anesth

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“…1 Itching, unfortunately, is a well-known side effect of IT narcotics. [10][11][12] IT lidocaine and sufentanil caused pruritus in 50% of patients in our study but did not delay discharge from the PACU. No other adverse events differed between the two groups.…”

Section: R Re Es Su Ul Lt Ts Smentioning

confidence: 85%

“…9 However, many patients suffer from pruritus induced by IT opiate. [10][11][12] The frequency of pruritus associated with IT opioids ranges between 20 and 80%. 7,10 We hypothesized that low-dose IT lidocaine (15 mg) and sufentanil (10 µg) would shorten the time to ambulation when compared to IT lidocaine, at the conventional dose of 50 mg, for spinal anesthesia in patients undergoing short rectal surgery.…”

Section: Méthode : Quarante-neuf Patients (Asa I-iii De 20 à 69 Ans)mentioning

confidence: 99%

L’administration intrathécale de lidocaïne et de sufentanil diminue le temps de récupération après une opération du rectum en chirurgie ambulatoire

Waxler¹,

Mondragon²,

Patel³

et al. 2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : A short recovery time for same day surgery is important to the patient and the hospital. A prospective, randomized, doubleblinded study in the postanesthetic care unit was designed to compare the recovery time from spinal anesthesia with low-dose intrathecal (IT) lidocaine and sufentanil to that with IT lidocaine alone. The incidence of adverse effects was also assessed.M Me et th ho od ds s: : Forty-nine patients (ASA I-III, age 20-69 yr) underwent spinal anesthesia for rectal surgery. The patients were randomized into two groups. One group (n = 28) received low-dose IT lidocaine (15 mg) and sufentanil (10 µg) and the other group (n = 21) received IT lidocaine (50 mg). The time to ambulation, the incidence of pruritus, and other variables were recorded. Statistical difference was assumed if P < 0.05.

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Mechanisms and treatment of opioid‐induced pruritus: Peripheral and central pathways

Okutani,

Lo Vecchio,

Arendt‐Nielsen

2023

European Journal of Pain

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Background and ObjectivePruritus (also known as itch) is defined as an unpleasant and irritating sensation of the skin that provokes an urge to scratch or rub. It is well known that opioid administration can cause pruritus, which is paradoxical as itch and pain share overlapping sensory pathways. Because opioids inhibit pain but can cause itching. Significant progress has been made to improve our understanding of the fundamental neurobiology of itch; however, much remains unknown about the mechanisms of opioid‐induced pruritus. The prevention and treatment of opioid‐induced pruritus remains a challenge in the field of pain management. The objective of this narrative review is to present and discuss the current body of literature and summarize the current understanding of the mechanisms underlying opioid‐induced pruritus, and its relationship to analgesia, and possible treatment options.ResultsThe incidence of opioid‐induced pruritus differs with different opioids and routes of administration, and the various mechanisms can be broadly divided into peripheral and central. Especially central mechanisms are intricate, even at the level of the spinal dorsal horn. There is evidence that opioid receptor antagonists and mixed agonist and antagonists, especially μ‐opioid antagonists and κ‐opioid agonists, are effective in relieving opioid‐induced pruritus. Various treatments have been used for opioid‐induced pruritus; however, most of them are controversial and have conflicting results.ConclusionThe use of a multimodal analgesic treatment regimen combined with a mixed antagonist and κ agonists, especially μ‐opioid antagonists, and κ‐opioid agonists, seems to be the current best treatment modality for the management of opioid‐induced pruritus and pain.SignificanceOpioids remain the gold standard for the treatment of moderate to severe acute pain as well as cancer pain. It is well known that opioid‐induced pruritus often does not respond to regular antipruritic treatment, thereby posing a challenge to clinicians in the field of pain management. We believe that our review makes a significant contribution to the literature, as studies on the mechanisms of opioid‐induced pruritus and effective management strategies are crucial for the management of these patients.

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Pruritus—itching for a cause and relief?

Cited by 67 publications

References 48 publications

L’administration prophylactique d’ondansétron ne réduit pas l’incidence de prurit induit par le sufentanil intrathécal

L’administration prophylactique d’ondansétron ne réduit pas l’incidence de prurit induit par le sufentanil intrathécal

L’administration intrathécale de lidocaïne et de sufentanil diminue le temps de récupération après une opération du rectum en chirurgie ambulatoire

Mechanisms and treatment of opioid‐induced pruritus: Peripheral and central pathways

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