An update in the management of opioid-induced pruritus

What is it about?

The itching or pruritus is a secondary effect very annoying that appears after the neuraxial administration (epidural or intrathecal) of opioid drugs. Sometimes it can even be more unpleasant than the own pain by itself. Either prevention or treatment remains a challenge in the clinical practice of care for these patients. A wide variety of medications with different mechanisms of action have been used and focused on its management, with widely varying results. The objective of this article is to review the literature and summarize the current evidence of the mechanisms and pharmacological treatments available to handle pruritus induced by spinal opioids. The source of articles of this review was obtained through PubMed, Medline and Scopus until December 2016. These search results have been limited to the randomized controlled trials, systematized or comprehensive reviews and from opinion articles of experts in the subject. The most useful drugs are opioid mu antagonists, as naloxone, and mixed opioids kappa agonists /mu antagonists, as nalbuphine and butorphanol, the latter being able in addition to maintaining the analgesia. They have also shown some effectiveness, but to a lesser degree, from receptor antagonists of the serotonin 5-HT3, as ondansetron, administered prophylactically, and the antagonists of dopaminergic receptors D2, as dehidrobenzoperidol. Finally, ​sub anesthetic low dose of propofol and prophylactic oral mirtazapine and gabapentin have been used with medium results.

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