Pharmacologic Methods for Preventing Pruritus in Patients Receiving Intrathecal Opioids for Cesarean Delivery.

Neuraxial anesthesia with the addition of opioids is the preferred technique for cesarean delivery because of the safety and efficacy of the technique compared with general anesthesia. However, pruritus associated with neuraxial opioids is reported by patients to be one of the most distressing side effects and is a source of patient dissatisfaction. The incidence of pruritus has been reported to be as high as 100%. This review examines the efficacy of different medications for the prevention of pruritus. An online database search of PubMed, Cochrane Database of Systemic Reviews, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar revealed 127 potential evidence sources. Fifteen randomized controlled studies met the inclusion criteria. Mixed opioid agonist-antagonists and dopaminer-gic receptor antagonists were found to be effective. Antihistamines, opioid antagonists, corticosteroids, and nonsteroidal anti-inflammatory drugs were found to be ineffective for the prevention of pruritus. Results conflicted regarding the efficacy of serotonin receptor antagonists and γ-aminobutyric acid receptor agonists for the prevention of pruritus caused by intrathecal opioid administration. The most promising evidence supported the use of nalbuphine and perhaps ondansetron. Findings of this review were incorporated into protocols for pain management for patients undergoing cesarean delivery and receiving intrathecal opioids.