Nalbuphine for the treatment of opioid-induced pruritus: a systematic review

      Opioid-induced pruritus is a common side-effect in patients with acute pain associated with surgery or childbirth. There are several options available to treat opioid-induced pruritus, including nalbuphine. However, it is not known whether nalbuphine offers greater efficacy in treating pruritus without attenuation of analgesia and increase in the incidence of adverse outcomes. A systematic search of studies assessing treatment efficacy of nalbuphine was conducted through Medline, PubMed, Cochrane Library, CINAHL and ProQuest databases. The primary outcome was incidence reduction of pruritus, while the secondary outcomes included analgesia and adverse outcomes. Ten studies that met all inclusion criteria were identified, nine of which were randomized controlled trials and one case report. The incidence of pruritus was higher among patients receiving neuraxial opioids. Nalbuphine provided greater efficacy in treating opioid-induced pruritus when compared to placebo, control or other pharmacologic agents such as diphenhydramine, naloxone and propofol. There was no attenuation of analgesia or increased in sedation with low dose nalbuphine treatment. Further, nalbuphine was associated with incidence reduction of nausea or vomiting; and reversal of respiratory depression. Nalbuphine is superior in treating opioid-induced pruritus when compared to placebo, control, diphenhydramine, naloxone or propofol in patients receiving opioids for acute pain related to surgery or childbirth. Therefore, it is recommended that nalbuphine should be used as first line treatment of opioid-induced pruritus.