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Treatment of Intrathecal Morphine Induced Pruritus in Women Post Cesarean Delivery : A Systematic Review
Abstract Number: T-14
Abstract Type: Meta Analysis/Review of the Literature
Pruritus after intrathecal morphine has a high incidence of 60-100% in patients undergoing cesarean delivery (CD) and commonly leads to maternal dissatisfaction as it can be severe.(1) It is often refractory to conventional antipruritic treatment due to its multifactorial etiology. A variety of medications have been used to treat pruritus, with varying success rates.(2,3) We therefore performed this systematic review to evaluate the efficacy of different drugs used for the treatment of intrathecal morphine-induced pruritus in women undergoing CD.
This systematic review was planned in accordance with the PRISMA guidelines. The protocol was defined a priori. An expert literature search of multiple electronic databases was conducted. We included RCTs that compared drugs used for treatment of pruritus in women undergoing cesarean delivery under spinal anesthesia with intrathecal morphine. Relevant trials had to report on the treatment success for all the drugs. Quality of the studies was assessed using modified oxford scoring system. Percentage statistics was used to calculate the success rate of the drugs used for the treatment of pruritus.
Seven studies (727 parturients) met inclusion criteria.(Table 1). Only 2 studies included a control group and hence a meta-analysis could not be done. Methodological validity scores determined by modified oxford score ranged from 4 to 7 indicating a low risk of bias. Four studies assessed ondansetron for the treatment of pruritus with a success rate of 76.49%. There was a recurrence of pruritus within 12 hours after successful treatment in 20.54%. Pentazocine was evaluated in one study, with a success rate of 96.15%. Nalbuphine was evaluated in 3 studies, with an overall success rate of 89.75%. Two studies examined IV diphenhydramine with a success rate of 68.83%. Propofol was successful in treating pruritus in only 53.27% of patients.
This systematic review comprehensively reports all the drugs used in the literature for the treatment of pruritus. Pentazocine and nalbuphine have a high overall success rate. Our findings are limited by the small number of studies. Further studies are needed to evaluate the most effective drug for the treatment of intrathecal morphine induced pruritus without recurrences.
1. J Clin Anesth 2003;15:234–9.
2. Anesth Analg 2009;109:1606–11.
3. Acta Anaesthesiol Scand 2010;54:764–9.