Why do Pain Physicians Not Routinely Use Mixed Opioids for the Prevention of Neuraxial Opioid-induced Pruritus?

Bujedo, Borja Mugabure

doi:10.2174/1876386301710010014

Cited by 2 publications

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References 25 publications

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“…On the other hand, IV nalbuphine (4 mg) seems to demonstrate the greater effectiveness and should be considered as the first line of treatment of OIP. [49]…”

Section: Discussionmentioning

confidence: 99%

Current Update in the Management of Post-operative Neuraxial Opioid-induced Pruritus

Bujedo¹

2018

J Clin Res Anesthesiol

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Introduction:Itching is an extremely bothersome side effect that frequently appears after the epidural and intrathecal administration of opioids. This common side effect can be severe enough to be considered by the patient to be as bad or worse than the pain itself. Both prevention and treatments remain a challenge in the clinical management of these patients. Many drugs have been used to either treat or prevent the condition with variable results. Materials and Methods: This article's purpose is to review the clinical literature and summarize the current evidence of efficacy and efficiency of pharmacological treatments available to manage opioid-induced pruritus mediated by spinal opioids in the post-operative setting. An analysis of how the mechanism of action of the most common drugs affects in their clinic usefulness is presented. This comprehensive review is limited to published papers in English, found on PubMed, Medline, and Scopus until December 2017. The papers used in this review were systematized reviews, randomized controlled trials, and opinion articles by subject experts. Results: The most useful drugs are mu opioid antagonists, such as naloxone, and mixed opioids kappa agonists/mu antagonists, such as nalbuphine and butorphanol, the latter being capable of maintaining analgesia in addition to reduce itching. Some efficacy has also been observed, to a lesser extent, from 5-hydroxytryptamine 3 serotonin receptor antagonists, such as prophylactically administered ondansetron, and D2 dopaminergic receptor antagonists, such as droperidol. Moreover, propofol at subanesthetic doses, midazolam, and prophylaxis with mirtazapine and oral gabapentin have been used with efficacy. Finally, a clinical practical guide is suggested for general management of pruritus induced by spinal opioids in the perioperative setting.

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“…On the other hand, IV nalbuphine (4 mg) seems to demonstrate the greater effectiveness and should be considered as the first line of treatment of OIP. [49]…”

Section: Discussionmentioning

confidence: 99%