Subhypnotic Doses of Propofol Do not Relieve Pruritus Induced by Intrathecal Morphine After Cesarean Section

Beilin, Yaakov; Bernstein, Howard; Zucker-Pinchoff, Barbara; Zahn, Jeffrey; Zenzen, Wendy J.

doi:10.1097/00000539-199802000-00018

Cited by 19 publications

(19 citation statements)

References 16 publications

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“…5,6 Besides, pregnancy itself can cause many physiologic changes such as interaction of oestrogen with opioid receptors and increased cephalad spread of spinally administered drugs. 28 Moreover, the pharmacokinetic profiles of medications also change during pregnancy due to altered activity of drugmetabolizing enzymes. A study has shown that the pharmacokinetics of ondansetron are altered during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Ondansetron for neuraxial morphine-induced pruritus: A meta-analysis of randomized controlled trials

Wang

Zhou

2017

J Clin Pharm Ther

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SummaryWhat is known and objective: Pruritus is one of the most common adverse effects associated with neuraxial morphine. Ondansetron has been used to deal with the problem of neuraxial morphine-induced pruritus (NMIP). The aim of this meta-analysis was to evaluate the preventive efficacy of ondansetron on NMIP. Methods: Online databases such as PubMed, EMBASE and the Cochrane CentralRegister of Controlled Trials were searched for eligible randomized controlled trials (RCTs). The primary outcome was the incidence of NMIP. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data. Trial sequential analysis (TSA) was performed to avoid the risk of making a spurious claim of significant effect and to calculate the sample size necessary to make a robust claim of effect. Results and discussion:Our traditional meta-analysis showed that prophylactic ondansetron could significantly reduce the incidence of NMIP in non-obstetric patients (three trials, RR=0.63, 95% CI 0.45-0.89, P=.008) with modest heterogeneity (I 2 =47%)while it did not show the preventive efficacy of NMIP in obstetric patients (seven trials, RR=0.84, 95% CI 0.69-1.03, P=.10) with obvious heterogeneity (I 2 =82% ). However, TSA demonstrates that more high-quality RCTs are still needed to confirm the preventive efficacy of ondansetron on NMIP in non-obstetric populations and to study whether ondansetron prevents NMIP in obstetric patients.What is new and conclusion: Prophylactic ondansetron can significantly reduce the incidence of NMIP in non-obstetric patients but not in obstetric patients. However, more well-designed trials are still required to test the reliability of the results in our traditional meta-analysis. K E Y W O R D Sclinical pharmacy, meta-analysis, morphine, ondansetron, pruritus to be applied in meta-analyses to assess the reliability of the evidence in traditional meta-analysis and provide the sample size necessary to make a robust claim of effect (termed as the required information size, RIS). 10,11 Therefore, we performed this study to evaluate the preventive efficacy of ondansetron on neuraxial morphine-induced pruritus. | WHAT IS KNOWN AND OBJECTIVE | METHODS This meta-analysis was conducted according to the PreferredReporting Items for Systematic Reviews and Meta-analyses (PRISMA)guidelines. 12 | Search strategyThree databases such as PubMed, EMBASE and the Cochrane CentralRegister of Controlled Trials were searched with language restriction to English for randomized controlled trials (RCTs) assessing the preventive effectiveness of ondansetron on NMIP. Besides, we also manually screened the reference lists of relevant reviews and studies for eligible articles. The search strategies for the three online databases were given in Appendix S1. The last search was conducted on 10 March 2017. | Eligibility criteria and study selectionFull-text RCTs published in English that compared the preventive efficacy of intravenous ondansetron versus control (namely, 0.9% normal saline) on pruritus induced by neuraxia...

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Section: Discussionmentioning

confidence: 99%

Ondansetron for neuraxial morphine-induced pruritus: A meta-analysis of randomized controlled trials

Wang

Zhou

2017

J Clin Pharm Ther

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“…22,23 Good alternative for opioid receptor antagonists Propofol 10-20 mg IV Depression of nerve transmission, possibly by potentiating the GABA-A receptor Data are conflicting. It may be effective as a prophylactic measure, 22,24 but seems to be less helpful for treatment of opioid-induced pruritus 11,25,26 Alizapride 50-100 mg IV Dopamine (D 2 ) receptor antagonist May have some benefits, 22,27 but due to the limited number of trials, has to be used with caution Diphenhydramine 25-50 mg orally every 4-6 h Histamine (H 1 ) receptor antagonist with anticholinergic activity Various antihistaminics, including diphenhydramine, can be recommended to control peripherally generated opioid-induced pruritus. 1 Diphenhydramine may produce a sedative effect.…”

Section: Prevention and Treatment Of Opioid-induced Pruritusmentioning

confidence: 99%

“…24 Interestingly, Warwick et al 25 stated that subhypnotic propofol was not effective for intrathecal morphine-induced pruritus in women after caesarean section. Beilin et al 26 in their prospective, randomized, double-blind controlled study reported that propofol did not relieve pruritus in women who underwent caesarean section and received intrathecal morphine sulfate for postoperative pain relief.…”

Section: Cyclooxygenase Inhibitionmentioning

confidence: 99%

Opioid-induced pruritus: an update

Reich

Szepietowski

2010

Clinical and Experimental Dermatology

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Pruritus is an unpleasant sensation leading to scratching. It can be a feature of numerous skin or systemic diseases, and may also be a side-effect of various drugs. Opioids are one of the best-known medicines evoking pruritus. The pathogenesis of opioid-induced pruritus is still not fully known, but two different mechanisms have been proposed: peripheral and central. Several treatment options have been tested for opioid-induced pruritus, but none has been completely satisfactory. Opioid antagonists seem to be the most potent antipruritic drugs, but they also decrease analgesia, which limits their usage. Many other treatments have been tried, but to date, the data are conflicting or only limited studies have been performed to confirm their efficacy. Further studies are still needed to better elucidate the mechanism of opioid-induced pruritus and to develop more effective treatment options.

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“…Of the 22 analysed trials, one was on treatment of established pruritus [33], and one on both, prevention and treatment (in two separate randomized designs) [34]. The others were on prevention only [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] ( Table 1).…”

Section: Retrieved Trialsmentioning

confidence: 99%

“…Within 8 h, one parturient in each group was completely free of pruritus (not significant). In the other trial [33], patients received 250 mg morphine intrathecally. Those who developed pruritus were treated either with propofol 10 mg once or twice, or Intralipid.…”

Section: Treatment Of Established Pruritusmentioning

confidence: 99%

Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials

Kjellberg

Tramèr

2001

European Journal of Anaesthesiology

130

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Background and objective Numerous drugs have been used to prevent or to treat opioid-induced pruritus in the surgical setting. Their relative efficacy is not well understood. Methods The methods employed involved the systematic search (MEDLINE, EMBASE, Cochrane library, bibliographies, without language restriction, up to June 2000) for full reports of randomized comparisons of any intervention which is thought to be anti-pruritic (active) compared with placebo or no treatment (control) in surgical (including labour) patients receiving opioids. The number of patients who had no pruritus were analysed using relative risk and number-neededto-treat with 95% confidence interval. Results Twenty-two trials (1477 patients) were analysed. Two trials (66 patients), both with low-dose propofol, were on treatment of established pruritus; propofol had no anti-pruritic effect compared with Intralipid. In prophylaxis trials, the average incidence of pruritus with control was 59% (range, 10% to 100%). Most mu-receptor antagonists were efficacious: intravenous naloxone 0.25-2.4 mg kg À1 h À1 , relative risk 2.31 (95% confidence interval, 1.5 to 3.54), numberneeded-to-treat to prevent pruritus compared with control 3.5; oral naltrexone 9 mg, relative risk 2.80 (1.35-5.80), number-needed-to-treat 1.7; naltrexone 6 mg was less effective and 3 mg did not work; different intravenous and epidural nalbuphine regimens, relative risk 1.71 (1.12-2.62), number-needed-to-treat 4.2. Intravenous nalmefene 0.5 or 1 mg was not antipruritic. Intravenous (but not epidural) droperidol 2.5 mg was efficacious, relative risk, 1.71 (1.28-2.29), number-needed-to-treat 4.9. There was a lack of evidence for any anti-pruritic efficacy with prophylactic propofol, epidural or intrathecal epinephrine, epidural clonidine, epidural prednisone, intravenous ondansetron, or intramuscular hydroxyzine. Conclusion Naloxone, naltrexone, nalbuphine and droperidol are efficacious in the prevention of opioidinduced pruritus; minimal effective doses remain unknown. There is a lack of valid data on the efficacy of interventions for the treatment of established pruritus.

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Subhypnotic Doses of Propofol Do not Relieve Pruritus Induced by Intrathecal Morphine After Cesarean Section

Cited by 19 publications

References 16 publications

Ondansetron for neuraxial morphine-induced pruritus: A meta-analysis of randomized controlled trials

Ondansetron for neuraxial morphine-induced pruritus: A meta-analysis of randomized controlled trials

Opioid-induced pruritus: an update

Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials

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