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Pharmacologic Methods for Preventing Pruritus in Patients Receiving Intrathecal Opioids for Cesarean Delivery
Katrina Vice-O'Con1, Paul N Austin2, Marilyn A Pugh3
1is co-owner of Natchitoches Anesthesia Associates LLC. She practices at Natchitoches Regional Medical Center in Natchitoches, Louisiana. At the time this article was written, she was a doctoral student in the Doctor of Nurse Anesthesia Practice program at Texas Wesleyan University, Fort Worth, Texas.
Pruritus, a common side effect of neuraxial opioids during cesarean delivery, can be effectively prevented by mixed opioid agonist-antagonists and dopaminergic receptor antagonists. Other medications like antihistamines and corticosteroids were found ineffective for preventing opioid-induced pruritus.
Area of Science:
- Anesthesiology
- Obstetrics
- Pharmacology
Background:
- Neuraxial anesthesia with opioids is preferred for cesarean delivery due to safety and efficacy.
- Opioid-induced pruritus is a distressing side effect, impacting patient satisfaction.
- Pruritus incidence can be as high as 100%.
Purpose of the Study:
- To review the efficacy of various medications in preventing pruritus associated with neuraxial opioids for cesarean delivery.
- To identify effective pharmacological interventions for managing opioid-induced pruritus.
Main Methods:
- Systematic literature search of PubMed, Cochrane, CINAHL, and Google Scholar.
- Inclusion of 15 randomized controlled studies that met specific criteria.
- Analysis of evidence for different drug classes in pruritus prevention.
Main Results:
- Mixed opioid agonist-antagonists and dopaminergic receptor antagonists demonstrated effectiveness.
- Antihistamines, opioid antagonists, corticosteroids, and NSAIDs were ineffective.
- Conflicting results were observed for serotonin receptor antagonists and GABA receptor agonists.
- Nalbuphine and ondansetron showed the most promising evidence for prevention.
Conclusions:
- Specific drug classes are effective in preventing neuraxial opioid-induced pruritus during cesarean delivery.
- Nalbuphine and ondansetron are highlighted as promising agents.
- Findings can inform updated pain management protocols for cesarean delivery patients receiving intrathecal opioids.
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