Becker Leonie M, Teunissen Aart Jan W, Koopman Joseph S H A
Department of Cardiology, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands.
Department of Anaesthesiology, Maasstad Ziekenhuis, Rotterdam, The Netherlands.
J Pain Res. 2022 Jun 4;15:1633-1645. doi: 10.2147/JPR.S361225. eCollection 2022.
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.
在神经轴索麻醉中添加吗啡可改善术后镇痛效果并减少阿片类药物的用量，但常伴有瘙痒。关于预防或治疗瘙痒的研究结果相互矛盾。我们的目的是通过对临床试验的范围综述来确定预防或治疗瘙痒的有效药物。在PubMed、Embase和Web of Science中进行了系统的文献检索。我们纳入了调查成人神经轴索吗啡诱导瘙痒的预防或治疗的临床试验。筛选系统评价和荟萃分析以获取符合条件的研究。共纳入104篇文章，涵盖13个药理学组。我们得出结论，多巴胺拮抗剂、μ阿片受体激动剂/拮抗剂以及神经轴索或口服给予的μ阿片受体拮抗剂均可预防神经轴索吗啡引起的瘙痒，且与给药时间无关。在所综述的文献中，5HT3拮抗剂在吗啡给药前给药时可预防神经轴索吗啡诱导的瘙痒。对于神经轴索吗啡诱导的瘙痒治疗，似乎只有纳布啡始终有效。需要更多研究来确定最有效的剂量和有效药物的最佳给药时间。
