Subhypnotic Doses of Propofol Relieve Pruritus Induced by Epidural and Intrathecal Morphine

Borgeat, Alain; Wilder‐Smith, O. H. G.; Saiah, M.; Rifat, K.

doi:10.1097/00000542-199204000-00004

Cited by 136 publications

(8 citation statements)

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“…Propofol, an anesthetic reported to decrease pruritus induced by intrathecal morphine [117], has been reported to be associated with a decrease in the pruritus of cholestasis, at subhypnotic doses [117,118]. Years ago, lignocaine [119] was reported to improve this type of pruritus; considering the neural trajectory of pruritus, it is not difficult to conceive that some form of anesthesia may decrease the sensation of pruritus.…”

Section: Anestheticsmentioning

confidence: 99%

The pruritus of cholestasis

Bergasa

2005

Journal of Hepatology

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Section: Anestheticsmentioning

confidence: 99%

The pruritus of cholestasis

Bergasa

2005

Journal of Hepatology

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“…Systemic 5-HT3 antagonists ± (H) (Bonnet et al, 2008;Charuluxananan et al, 2003;Gulhas et al, 2007;Kung et al, 2014;Sarvela et al, 2006;Wells et al, 2004;Yeh et al, 2000) TRPV1 Systemic TRPV1 antagonists ± (H) (Beilin et al, 1998;Borgeat et al, 1992;Charuluxananan et al, 2001;Horta et al, 2006;Kostopanagiotou et al, 2006;Torn et al, 1994) D2 receptor…”

Section: -Ht3 Receptormentioning

confidence: 99%

“…Several studies have indicated the use of propofol for the treatment and prevention of opioid‐induced pruritus. For example, several authors have reported that the prophylactic administration of propofol significantly decreases the incidence of intrathecal morphine‐induced pruritus (Horta et al, 2006; Torn et al, 1994), and propofol in a subhypnotic dose (10–20 mg) is a suggested treatment for spinal morphine‐induced pruritus (Borgeat et al, 1992; Charuluxananan et al, 2001; Torn et al, 1994). An RCT showed that administering 20 mg of propofol reduced the incidence of morphine‐induced pruritus (Horta et al, 2006), whereas another study reported that propofol did not relieve pruritus in parturients who underwent caesarean section using intrathecal morphine (Beilin et al, 1998), and another RCT suggested that propofol‐based general anaesthesia was associated with a higher incidence of and more severe epidural morphine‐induced pruritus than thiopental‐sevoflurane‐based anaesthesia (Kostopanagiotou et al, 2006).…”

Section: Treatment Of Opioid‐induced Itchmentioning

confidence: 99%

Mechanisms and treatment of opioid‐induced pruritus: Peripheral and central pathways

Okutani,

Lo Vecchio,

Arendt‐Nielsen

2023

European Journal of Pain

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Background and ObjectivePruritus (also known as itch) is defined as an unpleasant and irritating sensation of the skin that provokes an urge to scratch or rub. It is well known that opioid administration can cause pruritus, which is paradoxical as itch and pain share overlapping sensory pathways. Because opioids inhibit pain but can cause itching. Significant progress has been made to improve our understanding of the fundamental neurobiology of itch; however, much remains unknown about the mechanisms of opioid‐induced pruritus. The prevention and treatment of opioid‐induced pruritus remains a challenge in the field of pain management. The objective of this narrative review is to present and discuss the current body of literature and summarize the current understanding of the mechanisms underlying opioid‐induced pruritus, and its relationship to analgesia, and possible treatment options.ResultsThe incidence of opioid‐induced pruritus differs with different opioids and routes of administration, and the various mechanisms can be broadly divided into peripheral and central. Especially central mechanisms are intricate, even at the level of the spinal dorsal horn. There is evidence that opioid receptor antagonists and mixed agonist and antagonists, especially μ‐opioid antagonists and κ‐opioid agonists, are effective in relieving opioid‐induced pruritus. Various treatments have been used for opioid‐induced pruritus; however, most of them are controversial and have conflicting results.ConclusionThe use of a multimodal analgesic treatment regimen combined with a mixed antagonist and κ agonists, especially μ‐opioid antagonists, and κ‐opioid agonists, seems to be the current best treatment modality for the management of opioid‐induced pruritus and pain.SignificanceOpioids remain the gold standard for the treatment of moderate to severe acute pain as well as cancer pain. It is well known that opioid‐induced pruritus often does not respond to regular antipruritic treatment, thereby posing a challenge to clinicians in the field of pain management. We believe that our review makes a significant contribution to the literature, as studies on the mechanisms of opioid‐induced pruritus and effective management strategies are crucial for the management of these patients.

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“…In one double-blind trial, propofol (10 mg IV) was observed to reduce morphine-induced pruritus compared to placebo (85% compared to 16%, respectively). 160 The patients in this study had received either epidural or spinal morphine for a variety of surgical procedures including gynecologic, gastrointestinal, thoracic, and orthopedic surgery. 160 Another study also reported that propofol (10 mg IV) protected against pruritus after intrathecal morphine for arthroplasty surgery.…”

Section: Propofolmentioning

confidence: 99%

“…160 The patients in this study had received either epidural or spinal morphine for a variety of surgical procedures including gynecologic, gastrointestinal, thoracic, and orthopedic surgery. 160 Another study also reported that propofol (10 mg IV) protected against pruritus after intrathecal morphine for arthroplasty surgery. 116 However, Warwick et al 117 did not confirm these findings in a double-blind study of obstetric patients; propofol (10 to 20 mg IV) had no effect on the onset or severity of pruritus after intrathecal morphine.…”

Section: Propofolmentioning

confidence: 99%

Evaluation of Therapies for Peripheral and Neuraxial Opioid-induced Pruritus based on Molecular and Cellular Discoveries

2021

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Opioids are a mainstay of treatment for pain worldwide. Pruritus, a common side effect of opioids, is a patient dissatisfier that limits their use in many clinical settings. Both parenteral and neuraxial administration of opioids frequently evoke pruritus. The ability of opioids to suppress pain while causing itch continues to perplex clinicians and researchers alike. Several mechanisms have been proposed to explain how opioids can give rise to pruritus, but specific knowledge gaps perpetuate debate. This review summarizes the clinical burden of opioid-induced pruritus and emphasizes recent discoveries of peripheral and central mechanisms for opioid-induced pruritus, particularly with respect to scientific and conceptual advances in spinal cord circuitry and mast cell biology. The mechanisms and effectiveness of existing medications used for clinical management of pruritus will be evaluated, and we will highlight the emerging preclinical utility of selective κ-opioid receptor agonists, such as nalfurafine, for the management of opioid-induced pruritus.

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Subhypnotic Doses of Propofol Relieve Pruritus Induced by Epidural and Intrathecal Morphine

Cited by 136 publications

References 0 publications

The pruritus of cholestasis

The pruritus of cholestasis

Mechanisms and treatment of opioid‐induced pruritus: Peripheral and central pathways

Evaluation of Therapies for Peripheral and Neuraxial Opioid-induced Pruritus based on Molecular and Cellular Discoveries

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