Severe non-opioid-induced pruritus following spinal block

Abstract

This case report describes an occurrence of intractable localized pruritus after spinal anesthesia in the absence of neuraxial opioid. Pruritus was confined to soles of booth feet. Symptoms were attributed to possible subclinical diabetic distal sensory neuropathy. Pruritus was refractory to IV diphenhydramine, IV lidocaine but responded quickly to subhypnotic dose of IV propofol. The close relationship between pathways for pain and pruritus may result in severe and unusual symptoms. Diagnostic workup should include tests for distal sensory neuropathy. Further understanding of neuropathic pruritus is needed.