Users Online: 269 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 


Table of Contents
Year : 2013  |  Volume : 29  |  Issue : 3  |  Page : 303-307

Neuraxial opioid-induced pruritus: An update

Department of Anesthesia, Schulich School of Medicine, London Health Sciences, Victoria Hospital, London, Ontario, Canada

Date of Web Publication27-Aug-2013

Correspondence Address:
Kamal Kumar
Fellow in Obstetric Anesthesia, Schulich School of Medicine, UWO, London, Ontario
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-9185.117045

Rights and Permissions

Pruritus is a troublesome side-effect of neuraxial (epidural and intrathecal) opioids. Sometimes it may be more unpleasant than pain itself. The prevention and treatment still remains a challenge. A variety of medications with different mechanisms of action have been used for the prevention and treatment of opioid-induced pruritus, with mixed results. The aim of this article is to review the current body of literature and summarize the current understanding of the mechanisms and the pharmacological therapies available to manage opioid-induced pruritus. The literature source of this review was obtained via PubMed, Medline and Cochrane Database of Systematic Reviews until 2012. The search results were limited to the randomized controlled trials, systemic reviews and non-systemic reviews.

Keywords: Complications, epidural, itching, neuraxial opioids, post-operative, pruritus, spinal

How to cite this article:
Kumar K, Singh SI. Neuraxial opioid-induced pruritus: An update. J Anaesthesiol Clin Pharmacol 2013;29:303-7

How to cite this URL:
Kumar K, Singh SI. Neuraxial opioid-induced pruritus: An update. J Anaesthesiol Clin Pharmacol [serial online] 2013 [cited 2022 Sep 28];29:303-7. Available from:

  Introduction Top

Neuraxial opioids are one of the most frequently used methods of analgesia after cesarean delivery and other surgical procedures. The beneficial effect of neuraxial opioids used either alone or in combination with the local anesthetics is to augment and prolong intraoperative and postoperative analgesia. A wide range of side-effects has been reported, out of which one is pruritus. [1]

Pruritus, a subjective unpleasant and irritating sensation that provokes an urge to scratch and the symptoms typically start at the trunk, nose, around the eyes and is usually localized to facial areas, innervated by the trigeminal nerve. [2] The spinal nucleus of the trigeminal nerve is rich in opioid receptors and is continuous with the substantia gelatinosa and Lissauer tract at C3-C4. [3] The ophthalmic division of the spinal sensory nucleus of the trigeminal nerve is most inferior; thus, supporting the observation that the pruritus following neuraxial opioid administration is typically in the nose and upper part of the face. [3]

The objective of this review is to understand the pathophysiology and mechanism of opioid-induced pruritus and review the current body of literature for evidence available for pharmacological therapies to manage opioid-induced pruritus.

Incidence and prevalence

The incidence of pruritus is 83% in postpartum patients and 69% in non-pregnant patients including males and females. [4],[5],[6],[7] Pregnant women seem to be more susceptible to pruritus after neuraxial opioid administration than other populations, with incidence of 60-100%. [2],[8],[9] In contrast, after orthopedic surgery, the incidence of pruritus after intrathecal opioid ranged from 30% to 60%. [10],[11],[12] This increased incidence may be due to an interaction of estrogen with opioid receptors. [13],[14]

Pruritus begins shortly after analgesia, with the onset depending on the type, route and dosage of opioid used. Pruritus invoked by lipid-soluble opioids such as fentanyl and sufentanil is of shorter duration, and the use of the minimum effective dose and addition of local anesthetics seems to decrease the prevalence and the severity of itching. Pruritus invoked by intrathecal morphine is of longer duration and is difficult to treat. [15] Intrathecal administration, of opioids reach peak concentrations in the cerebrospinal fluid almost immediately. [16],[17] After epidural administration, there is a delay in the rise to peak concentration (10-20 min with fentanyl and 1-4 h with morphine). [17],[18] Co-administration of epinephrine may have an influence on spinal and epidural opioid-induced side-effects, including pruritus. As a vasoconstrictor agent, epinephrine decreases the vascular uptake of the opioid from the spinal and epidural space, increasing opioid concentrations within the cerebrospinal fluid and therefore, possibly increasing the severity of side-effects. [1],[2]

Mechanism of neuraxial opioid-induced pruritus

The exact mechanism of neuraxial opioid-induced pruritus is unclear. Many mechanisms have been postulated, but no single mechanism can explain all instances.

Postulated mechanisms include: [15],[16],[19],[20],[21],[22],[23]

  • The presence of "itch center" in the central nervous system
  • Medullary dorsal horn activation and antagonism of inhibitory transmitters
  • Modulation of the serotonergic pathway
  • Theory linking pain and pruritus.
It appears pain and pruritus are transmitted by the same population of sensory neurons, namely small un-myelinated nerve fibers (C-fibers) and the release of prostaglandins (PGE1 and PGE2) enhance C-fiber transmission to the central nervous system, which potentiates pruritus. [24]

A high density of 5-hydroxytryptamine subtype 3 (5-HT3) receptor and μ receptors are present in the superficial layers of the dorsal horn and in the nucleus of the spinal tract of the trigeminal nerve in the medulla. The spinal trigeminal nucleus located superficially in the medulla is an integrative center for sensory input from the face and an area known as the "itch center." The Cephalic migration of neuraxial opioids toward this "itch center and activation of 5-HT3 receptors by opioids may play a role in the generation of neuraxial opioid-induced pruritis. [25],[26]

Opioids can also induce itching at the spinal level by "itch-selective" secondary neurons in the lamina I spino-thalamic tract of the dorsal horn. The active wide dynamic range or nociception-specific neurons of the dorsal horn inhibit these spinal itch neurons. If this inhibition is weakened by opioids, the disinhibited itch neurons become active and mediate itching, without stimulation of the primary afferent peripheral nerves. [26] Spinal triggering of itching is observed in particular by activation of μ-opioid receptors (MOR) although κ-opioid receptors (KOR) suppress itch. [26],[27],[28]

Prevention and treatment of opioid-induced pruritus

Treatment of neuraxial opioid-induced pruritus remains a challenge. It is often difficult to treat and is refractory to conventional antipruritic treatment. Several drugs have been tried with some evidence of efficacy. The pharmacological therapies including antihistamines, 5-HT3-receptor antagonists, opiate-antagonists, propofol, non-steroidal anti-inflammatory drugs (NSAIDs), and droperidol have been studied.

5-HT3 receptor antagonist

5-HT3 receptors are abundant in the dorsal horn of the spinal cord and the spinal tract of the trigeminal nerve in the medulla. The interaction between opioids and 5-HT3 receptors may play a role in the generation of neuraxial opioid-induced pruritus. [7],[8],[29] 5-HT3 antagonists, such as ondansetron, granisetron, and dolasetron have been used to prevent the neuraxial opioid-induced pruritus.

Systematic review of 15 randomized controlled trials (RCTs) indicates that prophylactic treatment with a single i.v. bolus of 5-HT3 receptor antagonists may provide a significant decrease in the incidence and the intensity score of pruritus after neuraxial opioid administration, particularly when morphine is used. It also suggested a significant decrease in the requirement for treatment of pruritis. [7] Dosage for the 5-HT3 receptor antagonists used were ondansetron four, and 8 mg, or 0.1 mg kg. [30] The other 5-HT3 receptor antagonists studied are Tropisetron (5 mg), granisetron (3 mg), and dolasetron (12.5 mg).

5-HT3 receptor antagonists reduced the incidence of pruritus after neuraxial morphine injection but not after neuraxial lipid-soluble opioids injection. One of the postulated mechanism is Morphine is less lipid-soluble and slow in the onset of analgesia, which gives higher residual opioid concentration in the cerebrospinal fluid and a greater cephalic migration. [31] As the peak concentration of ondansetron, occurs around 15 min, 5-HT3 antagonists may reach 5-HT3 receptors in the spinal cord before morphine, but not after the lipid-soluble drugs. [32],[33]

Opioid receptor antagonist

The μ receptor is responsible for pain modulation and some side-effects, especially pruritus and nausea or vomiting. Pre-treatment with clocinamox, a selective MOR antagonist inhibited intrathecal morphine-induced scratching in primates, but neither κ-opioid (binaltorphimine) nor δ-opioid receptor antagonists (naltrindole) produced this effect. This explained the antipruritic effect of μ receptor antagonists. [34] Several studies have evaluated the effectiveness of naloxone, naltrexone and methyl naltrexone in the prevention of opioid induced pruritus, but mixed results were seen. Based on the existing data, a low dose, continuous i.v. infusion of naloxone has the largest body of evidence supporting its use for prevention of opioid induced pruritus in adult. A continuous infusion produces less fluctuation of naloxone concentrations than bolus injections and compensates for naloxone's relatively short half-life. It appears that an intravenous dose of 0.25-1 μg/kg/h is the most effective without affecting analgesia. [35] A systematic review by Kjellberg and Tramθr [36] concluded that doses above 2 μg/kg/h. are more likely to lead to reversal of analgesia and thus are not recommended.

Mixed agonist - antagonist opioid

Mixed agonist - antagonist opioid has a potential to attenuate the μ-opioid effects and to enhance the κ-opioid effects. There is experimental evidence suggesting that activation of KOR attenuated morphine-induced itching without interfering with nociception in monkeys. [37] Studies have demonstrated that both MOR antagonists and - KOR agonists are effective in alleviating intrathecal morphine induced itch in primates. [38],[39] Effectiveness of nalbuphine, butorphanol, and pentazocine has also been studied with positive results. [6],[40],[41],[42]

Tamdee et al. performed a randomized trial to study the efficacy of pentazocine for the treatment of pruritus associated with intrathecal injection of morphine and concluded that pentazocine 15 mg is superior to ondansetron 4 mg for the treatment of intrathecal morphine-induced pruritus. [42]

Mixed agonist - antagonist opioid effectively prevents and treats opioid-induced pruritus without increasing pain, but the treatment may be complicated by increased drowsiness. [43] However, a recent study suggested that nalbuphine is not effective in the treatment of post-operative opioid-induced pruritus in the pediatric patients. [44]


NSAIDs have a well-recognized role in the relief of postoperative pain. They inhibit cyclooxygenases and decrease the formation of prostaglandins.

Tenoxicam and diclofenac have been shown to have anti-pruritic effects in patients receiving neuraxial opioids. [10],[45] However, Gulhas et al. [24] found no decrease in pruritus with the use of Lornoxicam following intrathecal fentanyl administration. Celecoxib have shown mixed results in having anti-pruritic effects. Lee et al. [46] found no reduction of pruritus with the use of celecoxib following intrathecal morphine administration. Their study failed to demonstrate any significant antipruritic or analgesic effects of celecoxib in a single dose of 200 mg (administered after delivery of baby) within the first 24 h post-operatively but Samimi et al. [47] used 400 mg celecoxib orally 1 h before surgery and showed the effectiveness of celecoxib in decreasing the incidence of Intrathecal morphine-induced pruritus .


H1 blockers have little or no effect on centrally induced pruritus; although, first-generation H1 receptor antagonists such as diphenhydramine or hydroxyzine may produce a sedative effect, which could sometimes, be helpful in patients with pruritus. They primarily interrupt the itch-scratch cycle by providing needed sleep but are not really effective at reducing the severity of the itch. [13]


Propofol has been used for the treatment and prevention of pruritus. It exerts its antipruritic action through the inhibition of the posterior horn transmission in the spinal cord. [11],[48],[49],[50],[51],[52],[53],[54] Many studies have been carried out with the sub-hypnotic propofol doses ranging from 10 mg bolus to 30 mg over 24 h, but results were conflicting. [5],[11],[25]


Mirtazapine is a new antidepressant that selectively blocks 5-HT2 and 5-HT3 receptors. Mirtazapine has a unique pharmacological profile apart from increasing noradrenergic and serotonergic neurotransmission; mirtazapine can exert its antidepressant and anti-nociception action through the κ-opioid system-opioid system. [51],[52] Its antipruritic activity was first reported by Davis et al.[53] Sheen et al. studied Mirtazapine to reduce intrathecal morphine-induced pruritus. [54] They concluded that pre-operative oral mirtazapine 30 mg decreased the incidence, delayed the onset time, decreased the severity, and shortened the duration of pruritus. Mirtazapine could exert its antipruritic effect through activating the κ-opioid system. Secondly, mirtazapine can work on the cerebral cortex to reduce the perception of pruritus. Thirdly, mirtazapine had strong antihistamine effect. From the pharmacokinetic viewpoint, mirtazapine has another advantage over the first-generation 5-HT3 receptor antagonists. The peak concentration of mirtazapine is reached 2 h. after a single dose and the elimination half-life ranges from 20 h to 40 h. [55] allowing the drug to cover the onset and duration of pruritus.

Dopamine D2 receptor antagonist

Droperidol and alizapride has also been used for the treatment of opioid-induced pruritus. Both are potent dopamine D2 receptor antagonist. Droperidol is also having weak anti-5-HT3 activity. In the study by Horta et al. [50] involving 300 women undergoing cesarean section, the intravenous droperidol subgroup showed the lowest prevalence of pruritus compared with placebo and also compared with propofol, alizapride, and promethazine. Metoclopramide, another dopamine D2 receptor antagonist has been shown to be ineffective in this regard. [56]


Gabapentin is an anticonvulsant, a structural analog of γ-amino butyric acid. Several studies have shown gabapentin to be effective in in many chronic pruritus conditions. [57],[58],[59],[60],[61] Sheen et al. studied the role of gabapentin in the management of intrathecal morphine-induced pruritus. [62] They concluded that pre-operative gabapentin 1200 mg decreased the incidence, delayed the onset time, decreased the severity, and shortened the duration of intrathecal morphine pruritus and it may be due to the multimodal anti pruritic action of gabapentin that includes central reduction of itch perception, [63] modulatory action on transmitter release, [64] which reduce the excitability of spinal and supraspinal neurons during itch transmission and spinal-supraspinal inhibition of serotonergic circuits. [65] Recently, Chiravanich et al. has carried out RCT on single dose of gabapentin as prophylaxis for intrathecal morphine-induced pruritus in orthopedic surgery. [66] They Concluded that pre-operative gabapentin 600 mg did not significantly reduces the post-operative intrathecal morphine-induced pruritus. Therefore, the effectiveness of antipruritic dosage and the other pharmacological mechanisms of gabapentin need further study.


The treatment of neuraxial opioid-induced pruritus is complex even after, significant research in these fields. We yet fail to describe a definitive treatment. Believing that prevention is better than cure and we suggest the use of minimal analgesic doses of neuraxial opioids, use of neuraxial opioids in combination with a local anesthetic, which offers satisfactory analgesia with a very low incidence of pruritus. [4] Drugs such as Tenoxicam, rectal diclofenac, pre-operative oral gabapentin, intravenous 5-HT3 antagonists, droperidol and subhypnotic dose of propofol have shown positive results for prevention of neuraxial opioid-induced pruritus and therefore, may be considered as possible prophylactic therapy.

  Conclusion Top

Pruritus is a well-recognized adverse effect of neuraxial opioids. It may have an impact on patient comfort, quality of life, and willingness to continue opioid therapy. Mechanism of intrathecal opioid-induced pruritus is complex and the literature data on the pathogenesis is still not clear. Many treatments have been tried, but to date, the data are conflicting and only limited studies have confirmed their efficacy. MOR antagonists, mixed opioid receptor agonist-antagonists, serotonin 5-HT3 receptor antagonists, and D2 receptor antagonists have been demonstrated most consistent in terms of attenuating opioid-induced pruritus.

  References Top

1.Ballantyne JC, Loach AB, Carr DB. Itching after epidural and spinal opiates. Pain 1988;33:149-60.  Back to cited text no. 1
2.Szarvas S, Harmon D, Murphy D. Neuraxial opioid-induced pruritus: A review. J Clin Anesth 2003;15:234-9.  Back to cited text no. 2
3.Kam PC, Tan KH. Pruritus: Itching for a cause and relief? Anaesthesia 1996;51:1133-8.  Back to cited text no. 3
4.Charuluxananan S, Somboonviboon W, Kyokong O, Nimcharoendee K. Ondansetron for treatment of intrathecal morphine-induced pruritus after cesarean delivery. Reg Anesth Pain Med 2000;25:535-9.  Back to cited text no. 4
5.Warwick JP, Kearns CF, Scott WE. The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for caesarean section. Anaesthesia 1997;52:270-5.  Back to cited text no. 5
6.Charuluxananan S, Kyokong O, Somboonviboon W, Narasethakamol A, Promlok P. Nalbuphine versus ondansetron for prevention of intrathecal morphine-induced pruritus after cesarean delivery. Anesth Analg 2003;96:1789-93.  Back to cited text no. 6
7.Bonnet MP, Marret E, Josserand J, Mercier FJ. Effect of prophylactic 5-HT3 receptor antagonists on pruritus induced by neuraxial opioids: A quantitative systematic review. Br J Anaesth 2008;101:311-9.  Back to cited text no. 7
8.Yeh HM, Chen LK, Lin CJ, Chan WH, Chen YP, Lin CS, et al. Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. Anesth Analg 2000;91:172-5.  Back to cited text no. 8
9.Shah MK, Sia AT, Chong JL. The effect of the addition of ropivacaine or bupivacaine upon pruritus induced by intrathecal fentanyl in labour. Anaesthesia 2000;55:1008-13.  Back to cited text no. 9
10.Colbert S, O'Hanlon DM, Galvin S, Chambers F, Moriarty DC. The effect of rectal diclofenac on pruritus in patients receiving intrathecal morphine. Anaesthesia 1999;54:948-52.  Back to cited text no. 10
11.Törn K, Tuominen M, Tarkkila P, Lindgren L. Effects of sub-hypnotic doses of propofol on the side effects of intrathecal morphine. Br J Anaesth 1994;73:411-2.  Back to cited text no. 11
12.Dimitriou V, Voyagis GS. Opioid-induced pruritus: Repeated vs single dose ondansetron administration in preventing pruritus after intrathecal morphine. Br J Anaesth 1999;83:822-3.  Back to cited text no. 12
13.Krajnik M, Zylicz Z. Understanding pruritus in systemic disease. J Pain Symptom Manage 2001;21:151-68.  Back to cited text no. 13
14.LaBella FS, Kim RS, Templeton J. Opiate receptor binding activity of 17-alpha estrogenic steroids. Life Sci 1978;23:1797-804.  Back to cited text no. 14
15.Reich A, Szepietowski JC. Opioid-induced pruritus: An update. Clin Exp Dermatol 2010;35:2-6.  Back to cited text no. 15
16.Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth 1995;42:891-903.  Back to cited text no. 16
17.Chauvin M, Samii K, Schermann JM, Sandouk P, Bourdon R, Viars P. Plasma pharmacokinetics of morphine after i.m., extradural and intrathecal administration. Br J Anaesth 1982;54:843-7.  Back to cited text no. 17
18.Gourlay GK, Murphy TM, Plummer JL, Kowalski SR, Cherry DA, Cousins MJ. Pharmacokinetics of fentanyl in lumbar and cervical CSF following lumbar epidural and intravenous administration. Pain 1989;38:253-9.  Back to cited text no. 18
19.Vercauteren MP, Vandeput DM, Meert TF, Adriaensen HA. Patient-controlled epidural analgesia with sufentanil following caesarean section: The effect of adrenaline and clonidine admixture. Anaesthesia 1994;49:767-71.  Back to cited text no. 19
20.Kyriakides K, Hussain SK, Hobbs GJ. Management of opioid-induced pruritus: A role for 5-HT3 antagonists? Br J Anaesth 1999;82:439-41.  Back to cited text no. 20
21.Nordberg G, Hedner T, Mellstrand T, Dahlström B. Pharmacokinetic aspects of intrathecal morphine analgesia. Anesthesiology 1984;60:448-54.  Back to cited text no. 21
22.Koenigstein H. Experimental study of itch stimuli in animals. Arch Derm Syphilol 1948;57:828-49.  Back to cited text no. 22
23.Hawkey CJ. COX-2 inhibitors. Lancet 1999;353:307-14.  Back to cited text no. 23
24.Gulhas N, Erdil FA, Sagir O, Gedik E, Togal T, Begec Z, et al. Lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus. J Anesth 2007;21:159-63.  Back to cited text no. 24
25.Ganesh A, Maxwell LG. Pathophysiology and management of opioid-induced pruritus. Drugs 2007;67:2323-33.  Back to cited text no. 25
26.Schmelz M. Opioid-induced pruritus. Mechanisms and treatment regimens. Anaesthesist 2009;58:61-5.  Back to cited text no. 26
27.Andrew D, Craig AD. Spinothalamic lamina I neurons selectively sensitive to histamine: A central neural pathway for itch. Nat Neurosci 2001;4:72-7.  Back to cited text no. 27
28.Stanfa LC, Singh L, Williams RG, Dickenson AH. Gabapentin, ineffective in normal rats, markedly reduces C-fibre evoked responses after inflammation. Neuroreport 1997;8:587-90.  Back to cited text no. 28
29.Fan P. Nonopioid mechanism of morphine modulation of the activation of 5-hydroxytryptamine type 3 receptors. Mol Pharmacol 1995;47:491-5.  Back to cited text no. 29
30.Tzeng JI, Chu KS, Ho ST, Cheng KI, Liu KS, Wang JJ. Prophylactic iv ondansetron reduces nausea, vomiting and pruritus following epidural morphine for postoperative pain control. Can J Anaesth 2003;50:1023-6.  Back to cited text no. 30
31.Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology 1984;61:276-310.  Back to cited text no. 31
32.Pernia A, Calderón E, Calderón Pla E, Torres LM. Ondansetron in the treatment of the pruritus associated with the spinal infusion of opiates. Rev Esp Anestesiol Reanim 2000;47:425-6.  Back to cited text no. 32
33.Pirat A, Tuncay SF, Torgay A, Candan S, Arslan G. Ondansetron, orally disintegrating tablets versus intravenous injection for prevention of intrathecal morphine-induced nausea, vomiting, and pruritus in young males. Anesth Analg 2005;101:1330-6.  Back to cited text no. 33
34.Ko MC, Song MS, Edwards T, Lee H, Naughton NN. The role of central mu opioid receptors in opioid-induced itch in primates. J Pharmacol Exp Ther 2004;310:169-76.  Back to cited text no. 34
35.Miller JL, Hagemann TM. Use of pure opioid antagonists for management of opioid-induced pruritus. Am J Health Syst Pharm 2011;68:1419-25.  Back to cited text no. 35
36.Kjellberg F, Tramèr MR. Pharmacological control of opioid-induced pruritus: A quantitative systematic review of randomized trials. Eur J Anaesthesiol 2001;18:346-57.  Back to cited text no. 36
37.Ko MC, Lee H, Song MS, Sobczyk-Kojiro K, Mosberg HI, Kishioka S, et al. Activation of kappa-opioid receptors inhibits pruritus evoked by subcutaneous or intrathecal administration of morphine in monkeys. J Pharmacol Exp Ther 2003;305:173-9.  Back to cited text no. 37
38.Lee H, Naughton NN, Woods JH, Ko MC. Effects of butorphanol on morphine-induced itch and analgesia in primates. Anesthesiology 2007;107:478-85.  Back to cited text no. 38
39.Togashi Y, Umeuchi H, Okano K, Ando N, Yoshizawa Y, Honda T, et al. Antipruritic activity of the kappa-opioid receptor agonist, TRK-820. Eur J Pharmacol 2002;435:259-64.  Back to cited text no. 39
40.Lawhorn CD, McNitt JD, Fibuch EE, Joyce JT, Leadley RJ Jr. Epidural morphine with butorphanol for postoperative analgesia after cesarean delivery. Anesth Analg 1991;72:53-7.  Back to cited text no. 40
41.Charuluxananan S, Kyokong O, Somboonviboon W, Lertmaharit S, Ngamprasertwong P, Nimcharoendee K. Nalbuphine versus propofol for treatment of intrathecal morphine-induced pruritus after cesarean delivery. Anesth Analg 2001;93:162-5.  Back to cited text no. 41
42.Tamdee D, Charuluxananan S, Punjasawadwong Y, Tawichasri C, Patumanond J, Sriprajittichai P. A randomized controlled trial of pentazocine versus ondansetron for the treatment of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. Anesth Analg 2009;109:1606-11.  Back to cited text no. 42
43.Waxler B, Dadabhoy ZP, Stojiljkovic L, Rabito SF. Primer of postoperative pruritus for anesthesiologists. Anesthesiology 2005;103:168-78.  Back to cited text no. 43
44.Nakatsuka N, Minogue SC, Lim J, Montgomery CJ, Court CA, Malherbe S, et al. Intravenous nalbuphine 50 microg x kg (-1) is ineffective for opioid-induced pruritus in pediatrics. Can J Anaesth 2006;53:1103-10.  Back to cited text no. 44
45.Colbert S, O'Hanlon DM, Chambers F, Moriarty DC. The effect of intravenous tenoxicam on pruritus in patients receiving epidural fentanyl. Anaesthesia 1999;54:76-80.  Back to cited text no. 45
46.Lee LH, Irwin MG, Lim J, Wong CK. The effect of celecoxib on intrathecal morphine-induced pruritus in patients undergoing Caesarean section. Anaesthesia 2004;59:876-80.  Back to cited text no. 46
47.Samimi S, Davari Tanha F, Malekian M. A blinded study using celecoxib for prevention of morphine induced pruritus in patients undergoing cesarean section. J Fam Reprod Health 2011;2:35-9.  Back to cited text no. 47
48.Saiah M, Borgeat A, Wilder-Smith OH, Rifat K, Suter PM. Epidural-morphine-induced pruritus: Propofol versus naloxone. Anesth Analg 1994;78:1110-3.  Back to cited text no. 48
49.Kostopanagiotou G, Pandazi A, Matiatou S, Kontogiannopoulou S, Matsota P, Niokou D, et al. The impact of intraoperative propofol administration in the prevention of postoperative pruritus induced by epidural morphine. Eur J Anaesthesiol 2006;23:418-21.  Back to cited text no. 49
50.Horta ML, Morejon LC, da Cruz AW, Dos Santos GR, Welling LC, Terhorst L, et al. Study of the prophylactic effect of droperidol, alizapride, propofol and promethazine on spinal morphine-induced pruritus. Br J Anaesth 2006;96:796-800.  Back to cited text no. 50
51.Schreiber S, Bleich A, Pick CG. Venlafaxine and mirtazapine: Different mechanisms of antidepressant action, common opioid-mediated antinociceptive effects: A possible opioid involvement in severe depression? J Mol Neurosci 2002;18:143-9.  Back to cited text no. 51
52.Schreiber S, Rigai T, Katz Y, Pick CG. The antinociceptive effect of mirtazapine in mice is mediated through serotonergic, noradrenergic and opioid mechanisms. Brain Res Bull 2002;58:601-5.  Back to cited text no. 52
53.Davis MP, Frandsen JL, Walsh D, Andresen S, Taylor S. Mirtazapine for pruritus. J Pain Symptom Manage 2003;25:288-91.  Back to cited text no. 53
54.Sheen MJ, Ho ST, Lee CH, Tsung YC, Chang FL, Huang ST. Prophylactic mirtazapine reduces intrathecal morphine-induced pruritus. Br J Anaesth 2008;101:711-5.  Back to cited text no. 54
55.Timmer CJ, Sitsen JM, Delbressine LP. Clinical pharmacokinetics of mirtazapine. Clin Pharmacokinet 2000;38:461-74.  Back to cited text no. 55
56.Horta ML, Vianna PT. Effect of intravenous alizapride on spinal morphine-induced pruritus. Br J Anaesth 2003;91:287-9.  Back to cited text no. 56
57.Winhoven SM, Coulson IH, Bottomley WW. Brachioradial pruritus: Response to treatment with gabapentin. Br J Dermatol 2004;150:786-7.  Back to cited text no. 57
58.Manenti L, Vaglio A, Costantino E, Danisi D, Oliva B, Pini S, et al. Gabapentin in the treatment of uremic itch: An index case and a pilot evaluation. J Nephrol 2005;18:86-91.  Back to cited text no. 58
59.Manenti L, Vaglio A. Gabapentin for uraemic pruritus. Nephrol Dial Transplant 2005;20:1278-9.  Back to cited text no. 59
60.Gunal AI, Ozalp G, Yoldas TK, Gunal SY, Kirciman E, Celiker H. Gabapentin therapy for pruritus in haemodialysis patients: A randomized, placebo-controlled, double-blind trial. Nephrol Dial Transplant 2004;19:3137-9.  Back to cited text no. 60
61.Yesudian PD, Wilson NJ. Efficacy of gabapentin in the management of pruritus of unknown origin. Arch Dermatol 2005;141:1507-9.  Back to cited text no. 61
62.Sheen MJ, Ho ST, Lee CH, Tsung YC, Chang FL. Preoperative gabapentin prevents intrathecal morphine-induced pruritus after orthopedic surgery. Anesth Analg 2008;106:1868-72.  Back to cited text no. 62
63.Summey BT Jr, Yosipovitch G. Pharmacologic advances in the systemic treatment of itch. Dermatol Ther 2005;18:328-32.  Back to cited text no. 63
64.Iannetti GD, Zambreanu L, Wise RG, Buchanan TJ, Huggins JP, Smart TS, et al. Pharmacological modulation of pain-related brain activity during normal and central sensitization states in humans. Proc Natl Acad Sci U S A 2005;102:18195-200.  Back to cited text no. 64
65.Suzuki R, Rahman W, Rygh LJ, Webber M, Hunt SP, Dickenson AH. Spinal-supraspinal serotonergic circuits regulating neuropathic pain and its treatment with gabapentin. Pain 2005;117:292-303.  Back to cited text no. 65
66.Chiravanich W, Oofuvong M, Kovitwanawong N. Single dose of gabapentin for prophylaxis intrathecal morphine-induced pruritus in orthopedic surgery: A randomized controlled trial. J Med Assoc Thai 2012;95:186-90.  Back to cited text no. 66

This article has been cited by
1 Reduction of serum level of interleukin-2 and pruritus severity after acupuncture at Quchi (LI11) in hemodialysis patients: a placebo-controlled randomized clinical trial
Dedi Ardinata, Rozaimah Zain-Hamid, Irma D. Mahadi, Hasan Mihardja
Journal of Acupuncture and Tuina Science. 2022;
[Pubmed] | [DOI]
2 Neuraxial Labor Analgesia: Maintenance Techniques
Elliott Callahan, Stephanie Lim, Ronald B. George
Best Practice & Research Clinical Anaesthesiology. 2022;
[Pubmed] | [DOI]
3 Mas-Related G Protein–Coupled Receptor-X2 and Its Role in Non-immunoglobulin E–Mediated Drug Hypersensitivity
Chalatip Chompunud Na Ayudhya, Hydar Ali
Immunology and Allergy Clinics of North America. 2022;
[Pubmed] | [DOI]
4 A Randomized Controlled Trial for Prevention of Postspinal Anesthesia Shivering in Gynecological Surgeries: Mirtazapine vs. Dexamethasone
Ibrahim M. Esmat, Ahmed M. Elsayed, Hazem M. El-Hariri, Tarek M. Ashoor, Basavana B. Goudra
Anesthesiology Research and Practice. 2022; 2022: 1
[Pubmed] | [DOI]
5 Pruritus, neuraxial morphine and recrudescence of oral herpes simplex and treatment: an educational review in obstetric patients
Peter Van de Putte, Jonathan S Jahr, Roland Gieraerts, Jamielynn Hanam-Jahr, Marc Van de Velde
Regional Anesthesia & Pain Medicine. 2022; : rapm-2021-
[Pubmed] | [DOI]
6 The Incidence of Itching in Thoracic Epidural Morphine Applications: Can Laboratory Parameters Be Effective in Predicting Itching?
Gulay Ulger, Ramazan Baldemir, Musa Zengin, Hilal Sazak, Ali Alagoz
Cureus. 2022;
[Pubmed] | [DOI]
7 Safety and efficacy of low-dose selective spinal anesthesia with bupivacaine and fentanyl as compared to intravenous sedation and port-site infiltration for outpatient laparoscopic tubal ligation: A randomized controlled trial
Priyasmita Sarkar, Yudhyavir Singh, Nishant Patel, Shailendra Kumar, Puneet Khanna, Lokesh Kashyap, Rajeshwari Subramaniam
Anesthesia: Essays and Researches. 2021; 15(3): 290
[Pubmed] | [DOI]
8 Chronic Intractable Pruritus in Chronic Kidney Disease Patients: Prevalence, Impact, and Management Challenges — A Narrative Review
Karolina Swierczynska, Rafal Bialynicki-Birula, Jacek C Szepietowski
Therapeutics and Clinical Risk Management. 2021; Volume 17: 1267
[Pubmed] | [DOI]
9 Significance of Statistical Analysis to the Acceptance of a Clinical Research Report - Actual Submitted Treatises and Responses from Reviewers
Masato HIRABAYASHI, Katsushi DOI, Noritaka IMAMACHI, Tomomune KISHIMOTO, Yoji SAITO
[Pubmed] | [DOI]
10 MRGPRX2 and Adverse Drug Reactions
Benjamin D. McNeil
Frontiers in Immunology. 2021; 12
[Pubmed] | [DOI]
11 Influence of Catheter–Incision Congruency in Epidural Analgesia on Postcesarean Pain Management: A Single-Blinded Randomized Controlled Trial
Ying-Hsi Chen, Wei-Han Chou, Jr-Chi Yie, Hsiao-Chun Teng, Yi-Luen Wu, Chun-Yu Wu
Journal of Personalized Medicine. 2021; 11(11): 1099
[Pubmed] | [DOI]
12 Pruritus after continuous administration of epidural morphine for post-cesarean delivery analgesia: a case control study
Xinyi Tian,Kaifan Niu,Hong Cao,Gonghao Zhan,Yan Zhang,Feng Xu,Wangning Shangguan,Ye Gao
BMC Pregnancy and Childbirth. 2021; 21(1)
[Pubmed] | [DOI]
13 Morphine acts on spinal dynorphin neurons to cause itch through disinhibition
Eileen Nguyen,Grace Lim,Huiping Ding,Junichi Hachisuka,Mei-Chuan Ko,Sarah E. Ross
Science Translational Medicine. 2021; 13(579): eabc3774
[Pubmed] | [DOI]
14 Patient-controlled epidural analgesia, patient-controlled intravenous analgesia, and conventional intravenous opioids for gynecologic interstitial brachytherapy: A single-center retrospective study
Yuya Murata,Kumiko Yamada,Yuto Hamaguchi,Tomohiro Ohigashi,Kazushi Maruo,Soichiro Yamashita,Makoto Tanaka
Brachytherapy. 2021;
[Pubmed] | [DOI]
15 Mechanistic insights into spinal neurones involved in neuraxial opioid-induced pruritus
Eileen Nguyen,Grace Lim,Sarah E. Ross
British Journal of Anaesthesia. 2021;
[Pubmed] | [DOI]
16 Assessment of main complications of regional anesthesia recorded in an acute pain unit in a tertiary care university hospital: a retrospective cohort
Marta G. Campos,Ana R. Peixoto,Sara Fonseca,Francisca Santos,Cristiana Pinho,Diana Leite
Brazilian Journal of Anesthesiology (English Edition). 2021;
[Pubmed] | [DOI]
17 P.106 Post-spinal patient satisfaction survey
A.C. Boyd,K. Whitehouse,S.J. Worthy
International Journal of Obstetric Anesthesia. 2021; 46: 103104
[Pubmed] | [DOI]
18 Oral analgesia in fixed-time interval administration versus spinal morphine for post-Cesarean pain: a randomised controlled trial
Enav Yefet,Salih Nassar,Julia Carmeli,Manal Massalha,Jamal Hasanein,Noah Zafran,Michael Rudin,Zohar Nachum
Archives of Gynecology and Obstetrics. 2021;
[Pubmed] | [DOI]
19 Medications for the prevention of pruritus in women undergoing cesarean delivery with Intrathecal morphine: A systematic review and bayesian network meta-analysis of randomized controlled trials
Yamini Subramani, Mahesh Nagappa, Kamal Kumar, Rokhsana Mortuza, Lee-Anne Fochesato, Moaz Bin Yunus Chohan, Janet Martin, Kevin Armstrong, Sudha (Indu) Singh
Journal of Clinical Anesthesia. 2021; 68: 110102
[Pubmed] | [DOI]
20 Characterization of Hyperacute Neuropathic Pain after Spinal Cord Injury: A Prospective Study
Jan Rosner,Michael Negraeff,Lise M. Bélanger,Angela Tsang,Leanna Ritchie,Jean-Marc Mac-Thiong,Sean Christie,Jefferson R. Wilson,Sanjay Dhall,Raphaele Charest-Morin,John Street,Tamir Ailon,Scott Paquette,Nicolas Dea,Charles G. Fisher,Marcel F. Dvorak,Nanna B. Finnerup,Brian K. Kwon,John L.K. Kramer
The Journal of Pain. 2021;
[Pubmed] | [DOI]
21 Neuroaxiale Gabe von Morphin nach Sectio caesarea: ein Update
Julia Oji-Zurmeyer,Clemens Ortner,Klaus Ulrich Klein,Günther Putz,Stefan Jochberger
AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie. 2021; 56(06): 439
[Pubmed] | [DOI]
22 Ondansetron versus ondansetron with dexamethasone to prevent intrathecal-morphine pruritus for caesarean patients: randomised double-blind trial
Thaer Ankouni,Saleh Kanawati,Rania El Khatib,Janah El Hassan,Saad Eddine Itani,Omar Rajab,Zoher Naja
Journal of Obstetrics and Gynaecology. 2021; : 1
[Pubmed] | [DOI]
23 Evaluation of Therapies for Peripheral and Neuraxial Opioid-induced Pruritus based on Molecular and Cellular Discoveries
Eileen Nguyen,Grace Lim,Sarah E. Ross
Anesthesiology. 2021; 135(2): 350
[Pubmed] | [DOI]
24 Central opioid receptors mediate morphine-induced itch and chronic itch via disinhibition
Zilong Wang,Changyu Jiang,Hongyu Yao,Ouyang Chen,Sreya Rahman,Yun Gu,Junli Zhao,Yul Huh,Ru-Rong Ji
Brain. 2020;
[Pubmed] | [DOI]
25 A prospective randomized controlled study of combined spinal-general anesthesia vs. general anesthesia for laparoscopic gynecological surgery: Opioid sparing properties
Marko Zdravkovic,Mirt Kamenik
Journal of Clinical Anesthesia. 2020; 64: 109808
[Pubmed] | [DOI]
26 Intrathecal Morphine Versus Ketamine in Postoperative Pain After Hysterectomy: Double-Blinded, Randomized Clinical Trial
Camila A. Carpi,Alahyr G.G. Neto,Rodrigo A. Gusmão,Thaís A.M. Silva,Marcus V. Gomez,Célio J. Castro-Junior
Journal of PeriAnesthesia Nursing. 2020;
[Pubmed] | [DOI]
27 Inhibition of itch by hunger and AgRP neuron activity
Amber L. Alhadeff,Onyoo Park,Elen Hernandez,J. Nicholas Betley
Neuroscience. 2020;
[Pubmed] | [DOI]
28 Estrategias de tratamiento analgésico tras cesárea. Estado actual y nuevas alternativas
F.J. Arroyo-Fernández,J.E. Calderón Seoane,L.M. Torres Morera
Revista Española de Anestesiología y Reanimación. 2020;
[Pubmed] | [DOI]
29 Strategies of analgesic treatment after cesarean delivery. Current state and new alternatives
F.J. Arroyo-Fernández,J.E. Calderón Seoane,L.M. Torres Morera
Revista Española de Anestesiología y Reanimación (English Edition). 2020;
[Pubmed] | [DOI]
30 Effectiveness of prophylactic intravenous ondasetron to reduce fentanyl induced pruritus among elective cesarean section patients in Worabe Comprehensive Specialized Hospital, Southern Ethiopia, 2020, randomized clinical trial
Abdi Hulchafo,Mr Silesh Abiy,Shukralla Shifa,Dessalegn Yemam
International Journal of Surgery Open. 2020;
[Pubmed] | [DOI]
31 Intranasal butorphanol rescue therapy for the treatment of intractable pruritus: A case series from the Johns Hopkins Itch Clinic
Raveena Khanna,Christina D. Kwon,Sagar P. Patel,Micah Belzberg,Kyle A. Williams,Ramona Khanna,Emily Boozalis,Shawn G. Kwatra
Journal of the American Academy of Dermatology. 2020;
[Pubmed] | [DOI]
32 Management of pain in colorectal cancer patients
Anna Zielinska,Marcin Wlodarczyk,Adam Makaro,Maciej Salaga,Jakub Fichna
Critical Reviews in Oncology/Hematology. 2020; : 103122
[Pubmed] | [DOI]
33 The Quality of Recovery after Dexamethasone, Ondansetron, or Placebo Administration in Patients Undergoing Lower Limbs Orthopedic Surgery under Spinal Anesthesia Using Intrathecal Morphine. A Randomized Controlled Trial
Eduardo Toshiyuki Moro,Miguel Antônio Teixeira Ferreira,Renyer dos Santos Gonçalves,Roberta Costa Vargas,Samira Joverno Calil,Maria Alice Soranz,Joshua Bloomstone
Anesthesiology Research and Practice. 2020; 2020: 1
[Pubmed] | [DOI]
34 Comparison of analgesic efficacy between rectus sheath blockade, intrathecal morphine with bupivacaine, and intravenous patient-controlled analgesia in patients undergoing robot-assisted laparoscopic prostatectomy: a prospective, observational clinical study
Jung-Woo Shim,Yun Jeong Cho,Minhee Kim,Sang Hyun Hong,Hyong Woo Moon,Sung Hoo Hong,Min Suk Chae
BMC Anesthesiology. 2020; 20(1)
[Pubmed] | [DOI]
35 Incidence and severity of pruritus in pregnant women undergoing lower-segment cesarean section under spinal anesthesia with fentanyl and bupivacaine
MohammedR Al-Tamimi,RashidM Khan
Indian Journal of Pain. 2020; 34(1): 39
[Pubmed] | [DOI]
36 Therapeutic Potential of Kappa Opioid Agonists
Tyler C. Beck,Matthew A. Hapstack,Kyle R. Beck,Thomas A. Dix
Pharmaceuticals. 2019; 12(2): 95
[Pubmed] | [DOI]
37 Heterogeneity of Human Mast Cells With Respect to MRGPRX2 Receptor Expression and Function
Gilda Varricchi,Antonio Pecoraro,Stefania Loffredo,Remo Poto,Felice Rivellese,Arturo Genovese,Gianni Marone,Giuseppe Spadaro
Frontiers in Cellular Neuroscience. 2019; 13
[Pubmed] | [DOI]
38 The Use of Naltrexone in Dermatology. Current Evidence and Future Directions
Mariusz Sikora,Adriana Rakowska,Malgorzata Olszewska,Lidia Rudnicka
Current Drug Targets. 2019; 20(10): 1058
[Pubmed] | [DOI]
39 Sub-hypnotic dose of propofol as antiemetic prophylaxis attenuates intrathecal morphine-induced postoperative nausea and vomiting, and pruritus in parturient undergoing cesarean section — a randomized control trial
Sylvanus Kampo,Alfred Parker Afful,Shiraj Mohammed,Michael Ntim,Alexis D. B. Buunaaim,Thomas Winsum Anabah
BMC Anesthesiology. 2019; 19(1)
[Pubmed] | [DOI]
40 The Role of Neuraxial Opioids in Pediatric Practice
Ardin S. Berger,Kenneth R. Goldschneider
The Clinical Journal of Pain. 2019; 35(6): 497
[Pubmed] | [DOI]
41 ACOG Practice Bulletin No. 209
Obstetrics & Gynecology. 2019; 133(3): e208
[Pubmed] | [DOI]
42 Monitoring, prevention and treatment of side effects of long-acting neuraxial opioids for post-cesarean analgesia
M. Yurashevich,A.S. Habib
International Journal of Obstetric Anesthesia. 2019;
[Pubmed] | [DOI]
43 Intravenous dexamethasone combined with intrathecal atropine to prevent morphine-related nausea and vomiting after cesarean delivery: A randomized double-blinded study
Esam Abdalla,Emad Zarief Kamel,Waleed Saleh Farrag
Egyptian Journal of Anaesthesia. 2019; 35(1): 59
[Pubmed] | [DOI]
44 Incidence and risk factors for epidural morphine induced pruritus in parturients receiving cesarean section
Xiao Tan,Le Shen,Lin Wang,Lin Labaciren,Yuelun Zhang,Xiuhua Zhang,Yuguang Huang
Medicine. 2019; 98(40): e17366
[Pubmed] | [DOI]
45 Determinants of womenæs dissatisfaction with anaesthesia care in labour and delivery
M. Yurashevich,B. Carvalho,A. J. Butwick,K. Ando,P. D. Flood
Anaesthesia. 2019;
[Pubmed] | [DOI]
46 Effect of Adding Magnesium Sulphate to Epidural Bupivacaine and Morphine on Post-Thoracotomy Pain Management: A Randomized, Double-Blind, Clinical Trial
Behrooz Farzanegan,Mahdi Zangi,Kimia Saeedi,Ali Khalili,Mehdi Rajabi,Alireza Jahangirifard,Habib Emami,Amir Ali Mahboobipour,Shadi Baniasadi
Basic & Clinical Pharmacology & Toxicology. 2018;
[Pubmed] | [DOI]
47 Prophylactic Nalbuphine to Prevent Neuraxial Opioid-Induced Pruritus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Tito D. Tubog,Jennifer L. Harenberg,Kristina Buszta,Jennifer D. Hestand
Journal of PeriAnesthesia Nursing. 2018;
[Pubmed] | [DOI]
48 Pruritus after intrathecal morphine for cesarean delivery: incidence, severity and its relation to serum serotonin level
M. Aly,A. Ibrahim,W. Farrag,K. Abdelsalam,H. Mohamed,A. Tawfik
International Journal of Obstetric Anesthesia. 2018;
[Pubmed] | [DOI]
49 Acupuncture for reducing pruritus induced by intrathecal morphine at elective cesarean delivery: a placebo-controlled, randomized, double-blind trial
Y. Mazda,T. Kikuchi,A. Yoshimatsu,A. Kato,S. Nagashima,K. Terui
International Journal of Obstetric Anesthesia. 2018;
[Pubmed] | [DOI]
50 Alloknesis and hyperknesis—mechanisms, assessment methodology, and clinical implications of itch sensitization
Hjalte Holm Andersen,Tasuku Akiyama,Leigh Ann Nattkemper,Antoinette van Laarhoven,Jesper Elberling,Gil Yosipovitch,Lars Arendt-Nielsen
PAIN. 2018; 159(7): 1185
[Pubmed] | [DOI]
51 Is There a Role for 5-HT3 Receptor Antagonists in the Treatment of Opioid-Induced Pruritus?
Saima Rashid,Disha D. Trivedi,Mudher Al-Shathir,Marie Moulton,Steven J. Baumrucker
American Journal of Hospice and Palliative Medicine®. 2018; 35(4): 740
[Pubmed] | [DOI]
52 Pruritus and postoperative nausea and vomiting after intrathecal morphine in spinal anaesthesia for caesarean section: Prospective cohort study
Yu Jia Thay,Qing Yuan Goh,Reena Nianlin Han,Rehena Sultana,Ban Leong Sng
Proceedings of Singapore Healthcare. 2018; 27(4): 251
[Pubmed] | [DOI]
53 NMDA receptor antagonists attenuate intrathecal morphine-induced pruritus through ERK phosphorylation
Le Shen,Weijia Wang,Siyu Li,Jing Qin,Yuguang Huang
Molecular Brain. 2018; 11(1)
[Pubmed] | [DOI]
Keisham Upendra Singh,Sukham Thoibahenba Singh,Sonia Nahakpam,Linthoingambi Samjetsabam,Zarina Waheb,Laishram Dhanachandra
Journal of Evolution of Medical and Dental Sciences. 2018; 7(48): 5184
[Pubmed] | [DOI]
Aynagul Zh. Bayalieva,J. N Yankovich
Regional Anesthesia and Acute Pain Management. 2018; 12(2): 76
[Pubmed] | [DOI]
56 Why do Pain Physicians Not Routinely Use Mixed Opioids for the Prevention of Neuraxial Opioid-induced Pruritus?
Borja Mugabure Bujedo
The Open Pain Journal. 2017; 10(1): 14
[Pubmed] | [DOI]
57 Prophylactic Pentazocine Reduces the Incidence of Pruritus After Cesarean Delivery Under Spinal Anesthesia With Opioids
Masato Hirabayashi,Katsushi Doi,Noritaka Imamachi,Tomomune Kishimoto,Yoji Saito
Anesthesia & Analgesia. 2017; 124(6): 1930
[Pubmed] | [DOI]
58 Ondansetron for neuraxial morphine-induced pruritus: A meta-analysis of randomized controlled trials
W. Wang,L. Zhou,L. Sun
Journal of Clinical Pharmacy and Therapeutics. 2017;
[Pubmed] | [DOI]
59 Perioperative benefit and outcome of thoracic epidural in esophageal surgery: a clinical review
P Feltracco,A Bortolato,S Barbieri,E Michieletto,E Serra,A Ruol,S Merigliano,C Ori
Diseases of the Esophagus. 2017;
[Pubmed] | [DOI]
60 Practice Bulletin No. 177
Obstetrics & Gynecology. 2017; 129(4): e73
[Pubmed] | [DOI]
61 In silico design of novel probes for the atypical opioid receptor MRGPRX2
Katherine Lansu,Joel Karpiak,Jing Liu,Xi-Ping Huang,John D McCorvy,Wesley K Kroeze,Tao Che,Hiroshi Nagase,Frank I Carroll,Jian Jin,Brian K Shoichet,Bryan L Roth
Nature Chemical Biology. 2017; 13(5): 529
[Pubmed] | [DOI]
62 Nalbuphine for Treatment of Opioid-induced Pruritus
Rose G. Jannuzzi
The Clinical Journal of Pain. 2016; 32(1): 87
[Pubmed] | [DOI]
63 Side Effects and Efficacy of Neuraxial Opioids in Pregnant Patients at Delivery: A Comprehensive Review
Sarah Armstrong,Roshan Fernando
Drug Safety. 2016;
[Pubmed] | [DOI]
64 Comparison of Ramosetron With Ondansetron for Prevention of Intrathecal Morphine-Induced Nausea and Vomiting After Primary Total Knee Arthroplasty: A Randomized Control Trial
Piya Pinsornsak,Mungkorn Teeyaphudit,Chaivet Ruetiwarangkoon,Adisai Chaiwuttisak
The Journal of Arthroplasty. 2016;
[Pubmed] | [DOI]
65 Optimal epidural analgesia for patients diagnosed as having gynecologic cancer undergoing interstitial brachytherapy
Ashley K. Amsbaugh,Mark J. Amsbaugh,Moataz N. El-Ghamry,Brian M. Derhake
Journal of Clinical Anesthesia. 2016; 35: 509
[Pubmed] | [DOI]
66 Sufentanil and Bupivacaine Combination versus Bupivacaine Alone for Spinal Anesthesia during Cesarean Delivery: A Meta-Analysis of Randomized Trials
Jiajia Hu,Chengliang Zhang,Jianqin Yan,Ruike Wang,Ying Wang,Mu Xu,Francesco Staffieri
PLOS ONE. 2016; 11(3): e0152605
[Pubmed] | [DOI]
67 Prophylactic Ondansetron for the Prevention of Intrathecal Fentanyl- or Sufentanil-Mediated Pruritus
Meghan Prin,Jean Guglielminotti,Vivek Moitra,Guohua Li
Anesthesia & Analgesia. 2016; 122(2): 402
[Pubmed] | [DOI]
68 An Update on Neuraxial Opioid Induced Pruritus Prevention
Journal of Anesthesia & Critical Care: Open Access. 2016; 6(3)
[Pubmed] | [DOI]
69 Comparison of epidural oxycodone and epidural morphine for post-caesarean section analgesia: A randomised controlled trial
BanLeong Sng, SarahCarol Kwok, Deepak Mathur, Farida Ithnin, Clare Newton-Dunn, PryseleyNkouibert Assam, Rehena Sultana, AlexTiong Heng Sia
Indian Journal of Anaesthesia. 2016; 60(3): 187
[Pubmed] | [DOI]
70 Intravenous Midazolam As More Effective Than Propofol for Preventing Pruritus After Intrathecal Sufentanil in Surgical Patients: A Randomized Blinded Trial
Jalil Makarem,Seyed Mohammad Mireskandari,Afshin Jafarzadeh,Laya Rahbar Nikoukar,Sara Aghaii
Anesthesiology and Pain Medicine. 2016; inpress(inpress)
[Pubmed] | [DOI]
71 Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus and post-operative nausea and vomiting in patients undergoing caesarean section
Ram Koju,Bandana Gurung,Yashad Dongol
BMC Anesthesiology. 2015; 15(1): 18
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article

 Article Access Statistics
    PDF Downloaded3638    
    Comments [Add]    
    Cited by others 71    

Recommend this journal