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Neuraxial opioid-induced pruritus: a review
Szilvia Szarvas1, Dominic Harmon, Damian Murphy
1Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital, Wilton Road, Cork, Ireland. szarvasszilvia@hotmail.com
Journal of Clinical Anesthesia
|May 29, 2003
Summary
Opioid administration can cause significant itching (pruritus), affecting up to 100% of patients. This review explores the unclear mechanisms and challenging treatments for neuraxial opioid-induced pruritus.
Area of Science:
- Anesthesiology and Pain Management
- Neuroscience
- Pharmacology
Background:
- Intrathecal and epidural opioids are frequently used for pain management.
- Pruritus is a common and distressing side effect, with reported incidences ranging from 30% to 100%.
- The precise mechanisms underlying opioid-induced pruritus are not fully understood.
Purpose of the Study:
- To review the current understanding of the pathophysiology of neuraxial opioid-induced pruritus.
- To summarize pharmacological advances and therapeutic strategies for managing this side effect.
- To highlight areas for future research to improve patient outcomes.
Main Methods:
- Literature review of pathophysiological mechanisms.
- Analysis of pharmacological interventions and clinical studies.
- Synthesis of data on treatment efficacy and challenges.
Main Results:
- Several mechanisms are postulated, including central nervous system "itch centers," medullary dorsal horn activation, and neurotransmitter antagonism.
- Numerous pharmacological agents have been investigated, including antihistamines, 5-HT(3)-receptor antagonists, opiate antagonists, propofol, NSAIDs, and droperidol.
- Effective treatment remains a significant clinical challenge.
Conclusions:
- Neuraxial opioid-induced pruritus is a complex issue with unclear mechanisms.
- Current pharmacological treatments offer limited and variable success.
- Further research into pathophysiology and novel therapeutics is crucial for effective management.