Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 4:15:1633-1645.
doi: 10.2147/JPR.S361225. eCollection 2022.

Prevention and Treatment of Neuraxial Morphine-Induced Pruritus: A Scoping Review

Leonie M Becker  1   2 , Aart Jan W Teunissen  2 , Joseph S H A Koopman  2
Affiliations

Prevention and Treatment of Neuraxial Morphine-Induced Pruritus: A Scoping Review

Leonie M Becker et al. J Pain Res. .

Abstract

The addition of morphine to neuraxial anaesthesia leads to improved postoperative analgesia and lower opioid consumption, but is often accompanied by pruritus. Studies on preventing or treating pruritus show contradictory results. Our objective was to identify effective drugs for the prevention or treatment of pruritus by a scoping review of clinical trials. A systematic literature search was conducted in PubMed, Embase and Web of Science. We identified clinical trials investigating the prevention or treatment of neuraxial morphine-induced pruritus in adults. Systematic reviews and meta-analyses were screened for eligible studies. One-hundred-and-four articles were included covering 13 pharmacological groups. We conclude that dopamine antagonists, µ-opioid agonist/antagonists and neuraxial or orally administered µ-opioid antagonists prevent pruritus caused by neuraxial morphine regardless of the timing of administration. In the reviewed literature, 5HT3-antagonists prevent neuraxial morphine-induced pruritus when administered before morphine administration. For the treatment of neuraxial morphine-induced pruritus, only nalbuphine appears to be consistently effective. More research is needed to find the most effective doses and the optimal timing of the effective medication.

Keywords: epidural; morphine; prevention; pruritus; spinal; treatment.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest. The authors have no sources of funding to declare for this manuscript

Figures

Figure 1
Figure 1
Flow diagram of the database search.
See this image and copyright information in PMC

References

    1. Koning MV, Teunissen AJW, van der Harst E, Ruijgrok EJ, Stolker RJ. Intrathecal Morphine for Laparoscopic Segmental Colonic Resection as Part of an Enhanced Recovery Protocol: a Randomized Controlled Trial. Reg Anesth Pain Med. 2018;43(2):166–173. doi: 10.1097/AAP.0000000000000703 - DOI - PMC - PubMed
    1. Koning MV, de Vlieger R, Teunissen AJW, et al. The effect of intrathecal bupivacaine/morphine on quality of recovery in robot-assisted radical prostatectomy: a randomised controlled trial. Anaesthesia. 2020;75(5):599–608. doi: 10.1111/anae.14922 - DOI - PMC - PubMed
    1. Horta ML, Morejon LCL, da Cruz AW, et al. Study of the prophylactic effect of droperidol, alizapride, propofol and promethazine on spinal morphine-induced pruritus. Br J Anaesth. 2006;96(6):796–800. doi: 10.1093/bja/ael072 - DOI - PubMed
    1. Koju RB, Gurung BS, Dongol Y. Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus and post-operative nausea and vomiting in patients undergoing caesarean section. BMC Anesthesiol. 2015;15:1. doi: 10.1186/1471-2253-15-18 - DOI - PMC - PubMed
    1. Swaro S, Karan D, Banerjee A. Comparison of Palonosetron, Dexamethasone, and Palonosetron Plus Dexamethasone as Prophylactic Antiemetic and Antipruritic Drug in Patients Receiving Intrathecal Morphine for Lower Segment Cesarean Section. Anesth Essays Res. 2014;12(2):322–327. doi: 10.4103/aer.AER_183_17 - DOI - PMC - PubMed

Publication types