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

Leonie M Becker,1,2 Aart Jan W Teunissen,2 Joseph SHA Koopman2 1Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands; 2Department of Anaesthesiology, Maasstad Ziekenhuis, Rotterdam, The NetherlandsCorrespondence: Leonie M Becker, Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435 CM, The Netherlands, Tel +31 88 320 09 22, Email l.becker@antoniusziekenhuis.nlAbstract: 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: pruritus, prevention, treatment, morphine, epidural, spinal