Abstract
(Anesthesiology. 2021;135:350–365) The clinical burden of opioid-induced pruritus is observed in many patient populations. Opioids are used to control numerous types of pain including acute, chronic, preoperative, intraoperative and postoperative, and cancer pain. Pruritus is an extremely common side effect of neuraxial opioids (30% to 85%) and also occurs with parenteral administration particularly after extended dosing. Pruritis secondary to neuraxial opioids in the childbirth setting is also extremely common (up to 85%) and is primarily dose dependent. Pruritus following neuraxial opioid administration is more common in women in all settings (60% to 85%), mirroring the elevated incidence of chronic pain that also affects female patients, perhaps implicating sensitivities of the μ-opioid receptor susceptible to the estrous cycle. Polymorphisms of the human μ-opioid receptor (OPRM1) may be associated with protection against the effects of pruritus.
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