Cochrane Database of Systematic Reviews

Drugs for the prevention and treatment of pruritus in patients

receiving neuraxial opioids (Protocol)

Suksompong S, Visalyaputra S, Suraseranivongse S, Pattanittum P

Suksompong S, Visalyaputra S, Suraseranivongse S, Pattanittum P.

Drugs for the prevention and treatment of pruritus in patients receiving neuraxial opioids.
Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD007251.
DOI: 10.1002/14651858.CD007251.

www.cochranelibrary.com

Drugs for the prevention and treatment of pruritus in patients receiving neuraxial opioids (Protocol)
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
 TABLE OF CONTENTS
HEADER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
BACKGROUND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
OBJECTIVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
METHODS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
CONTRIBUTIONS OF AUTHORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
DECLARATIONS OF INTEREST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Drugs for the prevention and treatment of pruritus in patients receiving neuraxial opioids (Protocol) i
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
[Intervention Protocol]

Drugs for the prevention and treatment of pruritus in patients

receiving neuraxial opioids

Sirilak Suksompong1 , Shusee Visalyaputra1 , Suwannee Suraseranivongse1 , Porjai Pattanittum2

1 Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 2 Department of

Biostatistics and Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen 40002, Thailand

Contact address: Sirilak Suksompong, Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2
Prannok Road, Siriraj, Bangkok-noi, Bangkok, 10700, Thailand. sisuk@mahidol.ac.th. si_suk@yahoo.com.

Editorial group: Cochrane Anaesthesia, Critical and Emergency Care Group.

Publication status and date: New, published in Issue 1, 2010.

Citation: Suksompong S, Visalyaputra S, Suraseranivongse S, Pattanittum P. Drugs for the prevention and treatment of pruri-
tus in patients receiving neuraxial opioids. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD007251. DOI:
10.1002/14651858.CD007251.

Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT

This is the protocol for a review and there is no abstract. The objectives are as follows:

The objective of this review is to evaluate the efficacy and safety of drugs for preventing or treating pruritus in patients receiving
neuraxial opioids.

We will evaluate whether drugs given prior to or after onset of pruritus alter the risks of pruritus and other side-effects (somnolence,
increased analgesic requirement) in patients receiving spinal or epidural opioids.

BACKGROUND Many mechanisms of spinal or epidural opioid-induced pruritus

Spinal and epidural (neuraxial) opioids have been widely used to have been postulated. No one mechanism can explain all instances.
treat acute postoperative pain since their clinical introduction in Furthermore, histamine may not be involved in the pruritus that
1979 (Behar 1979; Wang 1979). Their most common side effect occurs as a result of neuraxial opioids. One postulated mechanism
is pruritus, which may be very distressing (Gwirtz 1999). The in- is the stimulation of opioids at mu-opioid receptors in the trigem-
cidence of pruritus depends on many factors such as types of opi- inal nucleus and trigeminal nerve root (Ballantyne 1988). This
oids; route of administration, whether it is spinal or epidural; and explanation correlates with the clinical finding that pruritus most
type of local anaesthetic agent added (Shah 2000). The incidence commonly occurs in the facial area (Ballantyne 1988). Another
of pruritus in patients receiving epidural morphine and diamor- possible mechanism is the action of opioids at mu-opioid receptors
phine is higher than for those receiving methadone and pethidine in the substantia gelatinosa of the dorsal horn, which the trigemi-
(Gedney 1998). Meanwhile the incidence of pruritus after spinal nal nucleus continues into (Hu 1981; Scott 1982). The activation
sufentanil and fentanyl or spinal fentanyl and diamorphine are of kappa-opioid receptors can decrease spinal morphine-induced
comparable (Lane 2005; Nelson 2002). The dose of opioids may pruritus in primates (Ko 2003).
or may not affect the incidence of pruritus (Fuller 1990; Herman
1999). Many drug types have been used to prevent or treat neuraxial opi-
Drugs for the prevention and treatment of pruritus in patients receiving neuraxial opioids (Protocol) 1
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
oid-induced pruritus. These include opioid antagonists, opioid
agonist-antagonists, 5-HT3 -receptor antagonists, dopamine D2 -
receptor antagonists, H1 -receptor antagonists, catecholamines, in-
ductive agents such as propofol, and steroidal and nonsteroidal
inflammatory drugs. Besides the different groups of drugs used,
the dosage and route of administration of each drug have also been
studied.
The evidence supporting the use of each group of drugs is con-
flicting. The opioid antagonist naloxone appears to give good re-
sults in preventing and treating neuraxial opioid-induced pruritus
(Choi 2000; Gowan 1988). However, the right dose and the cor-
rect route are required for naloxone to demonstrate good efficacy
(Lockington 2007). Although naloxone can treat the pruritus it
also reverses the analgesic effect of the opioid; therefore, opioid ag-
onist-antagonists might do better. Nalbuphine has demonstrated
good results in treating opioid-induced pruritis (Charuluxananan
2001) while epidural butorphanol may or may not prevent spinal
or epidural opioid-induced pruritus (Gambling 1994; Lawhorn
1991). The popular 5-HT3 -receptor antagonist ondansetron has
been extensively studied, using different dosages and administra-
tion frequencies, with varying efficacies. Ondansetron has been
reported to be effective in treating neuraxial opioid-induced pru-
ritus (Borgeat 1999; Charuluxananan 2000). Five 4 mg postoper-
ative doses given over 48 hours have demonstrated better results
in preventing or reducing the severity of pruritus than a single
dose of ondansetron or placebo (Dimitriou 1999). Antihistamines
have not shown a better result than an opioid agonist-antagonist
(Alhashemi 1997). A study of butorphanol, a partial agonist at
kappa-opioid receptors, reported promising results in attenuating
neuraxial opioid-induced pruritus (Lee 2007).
Several review articles and one systematic review have been pub-
lished on pharmacological prevention of spinal or epidural opioid-
induced pruritus (Kjellberg 2001; Rathmell 2005; Szarvas 2003).
However, many new drugs such as granisetron, dolasetron and
alzapride were not included in these reviews. Therefore we intend
to update the clinical information on drugs for the prevention and
treatment of neuraxial opioid-induced pruritus.
OBJECTIVES
The objective of this review is to evaluate the efficacy and safety
of drugs for preventing or treating pruritus in patients receiving
neuraxial opioids.
We will evaluate whether drugs given prior to or after onset of
pruritus alter the risks of pruritus and other side-effects (somno-
lence, increased analgesic requirement) in patients receiving spinal
or epidural opioids.
Drugs for the prevention and treatment of pruritus in patients receiving neuraxial opioids (Protocol)
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
METHODS
Criteria for considering studies for this review
Types of studies
We will include randomized controlled trials (RCTs) that compare
any drug with active or inactive control to prevent or reduce the
severity of pruritus in patients receiving spinal or epidural opioids.
Types of participants
We will include all patients receiving neuraxial opioids and other
drugs that may decrease the incidence or severity of pruritus.
We will exclude all patients with pre-existing pruritus or pruritus
risk before receiving neuraxial opioids.
Types of interventions
Our experimental intervention will be any drug given before the
onset of pruritus compared with placebo, no treatment, or another
drug.
Types of outcome measures
Primary outcomes
Our primary outcomes are:
1. incidence of pruritus;
2. severity of pruritus.
Secondary outcomes
Our secondary outcomes are:
1. number of patient who had significant changes in sedation
score;
2. number of patient who had significant changes in pain
score;
3. other side effects such as dizziness or pain on injection.
Search methods for identification of studies
Electronic searches
We will search the Cochrane Central Register of Controlled Trials
(CENTRAL) (The Cochrane Library, current issue); Silver Platter
MEDLINE (WebSPIRS) (1950 to present); EMBASE (1988 to
present); LILACS (1992 to present).
2
Our searches will be reported in the appendices: CENTRAL (
Appendix 1); MEDLINE (Appendix 2); EMBASE (Appendix 3);
LILACS (Appendix 4).
We will search for relevant ongoing trials in specific web sites:
1. http://www.controlled-trials.com;
2. http://www.update-software.com.
We will combine the MEDLINE search strategy with the
Cochrane ’Highly sensitive search strategy, phases one and two’ as
contained in the Cochrane Handbook for Systematic Reviews of
Interventions (Higgins 2005).
We will check the reference list of relevant articles.
We will not apply a language restriction.
We will identify trials by handsearching abstracts of relevant con-
ference proceedings.
Data collection and analysis
Trial Identification
Two authors (SIRS and SHUV) will independently scan the titles
and abstracts of reports identified by electronic searching, manual
searching, and snowballing.
We will retrieve and evaluate potentially relevant studies, chosen
by at least one author, in full-text versions.
Trial selection
Two authors (SIRS and SHUV) will independently select trials
that meet the inclusion criteria using a checklist designed in ad-
vance for that purpose.
The third author (SUWS) will settle any disagreements.
Quality assessment
We will judge the study quality on the basis of the following.
1. Method of randomization.
2. Method of allocation concealment, where
i) low risk of bias; adequate allocation concealment with
central randomization (e.g. allocation by a central office unaware
of participant characteristics), use of a computer file that could
be accessed only after the characteristics of an enrolled
participant were entered, or other randomization description
containing elements suggesting adequate concealment;
ii) high risk of bias; unclear allocation concealment in
which the authors either did not report an allocation
concealment approach at all, or reported an approach that did
not fall into category A, or that indicated inadequate allocation
concealment (e.g. alternation or reference to case numbers or
dates of birth)
iii) no allocation concealment used; any procedure that
was entirely transparent before allocation (e.g. an open list of
Drugs for the prevention and treatment of pruritus in patients receiving neuraxial opioids (Protocol)
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
random numbers or other description that contained elements
indicating no concealment of allocation
3. Blinding to treatment and outcome assessment;
4. Completeness of follow up.
We will discuss the impact of methodological quality on the results.
We will perform a sensitivity analysis by either including or ex-
cluding categories B and C from the meta-analysis.
Data extraction
Two authors (SIRS and SHUV) will independently extract data
using a standardized checklist.
We will resolve any disagreement through consultation with the
third author (SUWS).
Statistics
We will quantitatively review the included data and combine it
by intervention, outcome, and population using The Cochrane
Collaboration’s statistical software (RevMan 5.0).
We will estimate the overall effects by meta-analysis if data are
available and trials are sufficiently similar. For dichotomous out-
comes, we will calculate the relative risk (RR), the odds ratio (OR),
and their respective 95% confidence intervals (CI). For continuous
outcomes, we will calculate weighted mean difference (WMD), or
standardized mean differences (SMD) where different scales were
used across studies to measure the same individual outcomes, to-
gether with their respective 95% confidence intervals (CIs).
We will test statistical heterogeneity by the Q test (P value < 0.1)
and I-squared (I2 ) test (I2 > 50%) (Higgins 2002). We will pool
clinically and statistically homogeneous studies using the fixed-
effect model. We will pool clinically homogeneous and statistically
heterogeneous studies using the random-effects model.
We will assess the possible sources of heterogeneity by performing
subgroup and sensitivity analyses if there are sufficient studies and
data:
• pregnant or general patient;
• sensitivity analysis based on quality of allocation
concealment.
ACKNOWLEDGEMENTS
We would like to thank Dr Jane Ballantyne (content editor); Dr
Martin Schmelz, Dr Vector Pace, and Dr Thomas Schricker (peer
reviewers); and Anne Lyddiat (consumer) for their help and ed-
itorial advice during the preparation of this protocol. We would
also like to thank Karen Hovhannisyan for his help in writing the
search strategy and process. Our appreciation also goes to Jane
Cracknell for co-ordinating this protocol and to Janet Wale for
copy editing the protocol.
3
 REFERENCES
Additional references
Alhashemi 1997
Alhashemi JA, Crosby ET, Grodecki W, Duffy PJ, Hull
KA, Gallant C. Treatment of intrathecal morphine-induced
pruritus following caesarean section. Canadian Journal of
Anaesthesia 1997;44(10):1060–5.
Ballantyne 1988
Ballantyne JC, Loach AB, Carr CB. Itching after epidural
and spinal opiates. Pain 1988;33(2):149–60.
Behar 1979
Behar M, Magora F, Olshwang D, Davidson JT. Epidural
morphine in treatment of pain. Lancet 1979;1(8115):
527–9.
Borgeat 1999
Borgeat A, Stirnemann HR. Ondansetron is effective
to treat spinal or epidural morphine induced pruritus.
Anesthesiology 1999;90(2):432–6.
Charuluxananan 2000
Charuluxananan S, Somboonviboon W, Kuokong O,
Nimcharoendee K. Ondansetron for treatment of intrathecal
morphine-induced pruritus after cesarean delivery. Regional
Anesthesia and Pain Medicine 2000;25(5):535–9.
Choi 2000
Choi JH, Lee J, Choi JH, Bishop MJ. Epidural naloxone
reduces pruritus and nausea without affecting analgesia by
epidural morphine in bupivacaine. Canadian Journal of
Anaesthesia 2000;47(1):33–7.
Dimitriou 1999
Dimitriou V, Voyagis GS. Opioid-induced pruritus:
repeated vs single dose ondansetron administration in
preventing pruritus after intrathecal morphine. British
Journal of Anaesthesia 1999;83(5):822–3.
Fuller 1990
Fuller JG, McMorland GH, Douglas MJ, Palmer L.
Epidural morphine for analgesia after caesarean section: a
report of 4880 patients. Canadian Journal Anaesthesia 1990;
37(6):636–40.
Gambling 1994
Gambling DR, Howell P, Huber C, Kozak S. Epidural
butorphanol does not reduce side effects from epidural
morphine after cesarean birth. Anesthesia and Analgesia
1994;78(6):1099–104.
Gedney 1998
Gedney JA, Liu EHC. Side-effects of epidural infusions of
opioids bupivacaine mixtures. Anaesthesia 1998;53(12):
1148–55.
Gowan 1988
Gowan JD, Hurtig JB, Fraser RA, Torbicki E, Kitts J.
Naloxone infusion after prophylactic epidural morphine:
effects on incidence of postoperative side-effects and quality
of analgesia. Canadian Journal of Anaesthesia 1988;35(2):
143–8.
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Gwirtz 1999
Gwirtz KH, Young JV, Byers RS, Alley C, Levin K,
Walker SG, et al. The safety and efficacy of intrathecal
opioid analgesia for acute postoperative pain: seven years’
experience with 5969 surgical patients at Indiana University
Hospital. Anesthesia and Analgesia 1999;88(3):599–604.
Herman 1999
Herman NL, Choi KC, Affleck PJ, Calicott R, Brackin
R, Singhal A, et al. Analgesia, pruritus, and ventilation
exhibit a dose-response relationship in parturients receiving
intrathecal fentanyl during labor. Anesthesia and Analgesia
1999;89(2):378–83.
Higgins 2002
Higgins JPT, Thompson SG. Quantifying heterogeneity in a
meta-analysis. Statistics in Medicine 2002;21(11):1539–58.
Higgins 2005
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Systematic Reviews of Interventions 4.2.2 [updated March
2005]. Appendices. The Cochrane Library, Issue 2, 2005.
Hu 1981
Hu JW, Dostrovsky JO, Sessle BJ. Functional properties of
neurons in cat trigeminal subnucleus caudalis (medullary
dorsal horn). I. Responses to oral-facial noxious and
nonnoxious stimuli and projections to thalamus and
subnucleus oralis. Journal of Neurophysiology 1981;45(2):
173–92.
Kjellberg 2001
Kjellberg F, Tramer MR. Pharmacological control of
opioids-induced pruritus: a quantitative systematic review
of randomized controlled trials. European Journal of
Anaesthesiology 2001;18(6):346–57.
Ko 2003
Ko MCH, Lee H, Song MS, Sobczyk-Kojiro K, Mosberg
HI, Kishioka S, et al. Activation of k-opioid receptors
inhibits pruritus evoked by subcutaneous or intrathecal
administration of morphine in monkeys. The Journal of
Pharmacology and Experimental Therapeutics 2003;305(1):
173–9.
Lane 2005
Lane S, Evans P, Arfeen Z, Misra U. A comparison of
intrathecal fentanyl and diamorphine as adjuncts in spinal
anaesthesia for caesarean section. Anaesthesia 2005;60(5):
453–7.
Lawhorn 1991
Lawhorn CD, McNitt JD, Fibuch EE, Joyce JT, Leadley RJ
Jr. Epidural morphine with butorphanol for postoperative
analgesia after cesarean delivery. Anesthsia and Analgesia
1991;72(1):53–7.
Lee 2007
Lee H, Naughton NN, Woods JH, Ko MC. Effects of
butorphanol on morphine-induced itch and analgesia in
primates. Anesthesiology 2007;107(3):478–85.
4
Lockington 2007
Lockington PF, Fa’aea P. Subcutaneous naloxone for the
prevention of intrathecal morphine induced pruritus in
elective caesarean delivery. Anaesthesia 2007;62(7):672–6.
Nelson 2002
Nelson KE, Rauch T, Terebuh V, D’Angelo R. A comparison
of intrathecal fentanyl and sufentanil for labor analgesia.
Anesthesiology 2002;96(5):1070–3.
Rathmell 2005
Rathmell JP, Lair TR, Nauman B. The role of intrathecal
drugs in the treatment of acute pain. Anesthesia and
Analgesia 2005;101(2 Suppl):30–43.
RevMan 5.0 [Computer program]
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Review Manager (RevMan). Version 5.0. Copenhagen:
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Scott PV, Fischer HBJ. Intraspinal opiates and itching: a
new reflex?. BMJ 1982;284(6321):1015–6.
Shah 2000
Shah MK, Sia AT, Chong JL. The effect of the addition
of ropivacaine or bupivacaine upon pruritus induced by
intrathecal fentanyl in labour. Anaesthesia 2000;55(10):
1008–13.
Szarvas 2003
Szarvas S, Harmon D, Murphy D. Neuraxial opioid-
induced pruritus: a review. Journal of Clinical Anesthesia
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Wang JK, Nauss LA, Thomas JE. Pain relief by intrathecally
applied morphine in man. Anesthesiology 1979;50(2):
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∗
Indicates the major publication for the study

APPENDICES

Appendix 1. CENTRAL search

1 MeSH descriptor Pruritus explode all trees

2 itching or pruritus

3 (#1 OR #2)

4 MeSH descriptor Drug Therapy, Combination, this term only

5 MeSH descriptor Drug Therapy, this term only

6 MeSH descriptor Drug Combinations, this term only

7 MeSH descriptor Antipruritics explode all trees

8 pharmacologic* near intervention*

9 (drug* near (prevent* or therapy)):ti,ab

10 antipruritic*

11 MeSH descriptor Analgesics, Opioid, this term only

Drugs for the prevention and treatment of pruritus in patients receiving neuraxial opioids (Protocol) 5
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
(Continued)

12 opioid* near (spinal or epidural or intrathecal)

13 (#4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12)

14 (#3 AND #13)

Appendix 2. Search strategy for SilverPlatter MEDLINE (WebSPIRS) (1950 to date)

1 explode “Pruritus-” / all SUBHEADINGS in MIME,MJME,PT

2 itching or pruritus

3 (itching or pruritus) near prevent*

4 #1 or #2 or #3

5 explode “Drug-Therapy-Combination” / all SUBHEADINGS in MIME,MJME,PT

6 explode “Drug-Therapy” / all SUBHEADINGS in MIME,MJME,PT

7 explode “Drug-Combinations” / WITHOUT SUBHEADINGS in MIME,MJME,PT

8 explode “Antipruritics-” / all SUBHEADINGS in MIME,MJME,PT

9 pharmacologic* near intervention*

10 drug* near prevent*

11 antipruritic*

12 explode “Analgesics-Opioid” / all SUBHEADINGS in MIME,MJME,PT

13 opioid* near (spinal or epidural or intrathecal)

14 “Pharmaceutical-Preparations” / all SUBHEADINGS in MIME,MJME,PT

15 #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14

16 #4 and #15

17 CLINICAL-TRIAL in PT

18 randomized in AB

Drugs for the prevention and treatment of pruritus in patients receiving neuraxial opioids (Protocol) 6
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
(Continued)

19 placebo in AB

20 (clinical trials) in MESH

21 randomly in AB

22 trial in TI

23 #17 or #18 or #19 or #20 or #21 or #22

24 TG=animals

25 TG=humans

26 #24 not (#24 and #25)

27 #23 not #26

28 #16 and #27

Appendix 3. Search strategy from SilverPlatter EMBASE (WebSPIRS) (1988 to date)

1 ”Pruritus-“ / all SUBHEADINGS

2 itching or pruritus

3 #1 or #2

4 antipruritic*

5 (drug* near (prevention or therapy)) in TI, AB

6 (drug* near (prevention or therapy or Combination*)) in TI, AB

7 pharmacologic* near intervention*

8 explode ”antipruritic-agent“ / all SUBHEADINGS in DEM,DER,DRM,DRR

9 ”analgesic-agent“ / all SUBHEADINGS in DEM,DER,DRM,DRR

10 opioid* near (spinal or epidural or intrathecal)

11 #4 or #5 or #6 or #7 or #8 or #9 or #10

12 #3 and #11

Drugs for the prevention and treatment of pruritus in patients receiving neuraxial opioids (Protocol) 7
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
(Continued)

13 RANDOMIZED-CONTROLLED-TRIAL”/ all subheadings

14 “RANDOMIZATION”/ all subheadings

15 “CONTROLLED-STUDY”/ all subheadings

16 “MULTICENTER-STUDY”/ all subheadings

17 “PHASE-3-CLINICAL-TRIAL”/ all subheadings

18 “PHASE-4-CLINICAL-TRIAL”/ all subheadings

19 “DOUBLE-BLIND-PROCEDURE”/ all subheadings

20 “SINGLE-BLIND-PROCEDURE”/ all subheadings

21 #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20

22 (RANDOM* or CROSS?OVER* or FACTORIAL* or PLACEBO* or VOLUNTEER*) in TI,AB

23 (SINGL* or DOUBL* or TREBL* or TRIPL*) near ((BLIND* or MASK*) in TI,AB)

24 #21 or #22 or #23

25 HUMAN in DER

26 (ANIMAL or NONHUMAN) in DER

27 #25 and #26

28 #26 not #27

29 #24 not #28

30 #12 and #29

Appendix 4. Search strategy for LILACS (1992 to date)

Search on

“PRURITUS” or “ITCHING/” or “itching$” or “pruritus$” or “picor” or “coceira” or “prurido” or “prurito” [Words] and “prevent$”
or “antipruritic$” or “opioid$” or “prevenci?n” or “preven??o” or “ANALGESICS, OPIOID/” or “ANTIPRURITICS” or “DRUG
THERAPY” or “DRUG COMBINATIONS” [Words]

Drugs for the prevention and treatment of pruritus in patients receiving neuraxial opioids (Protocol) 8
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
CONTRIBUTIONS OF AUTHORS
Conceiving the review: Sirilak Suksompong (SIRS), Shuvee Visalyapytra (SHUV)
Co-ordinating the review: SIRS
Undertaking manual searches: SIRS, Suwannee Suraseranivongse (SUWS)
Screening search results: SIRS, SHUV
Organizing retrieval of papers: SIRS, SHUV
Screening retrieved papers against inclusion criteria: SIRS, SHUV
Appraising quality of papers: SIRS, SHUV
Abstracting data from papers: SIRS, SHUV
Writing to authors of papers for additional information: SIRS
Providing additional data about papers: SIRS, SHUV
Obtaining and screening data on unpublished studies: SIRS, SHUV
Data management for the review: SIRS, SHUV
Entering data into Review Manager (RevMan 5.0): SIRS
RevMan statistical data: SIRS
Other statistical analysis not using RevMan: SIRS
Double entry of data: (data entered by person one: SIRS; data entered by person two:SUWS)
Interpretation of data: SIRS, SHUV
Statistical inferences: SIRS, Porjai Pattanittum (PORP)
Writing the review: SIRS, SHUV
Securing funding for the review:
Performing previous work that was the foundation of the present study:
Guarantor for the review (one author) SIRS
Person responsible for reading and checking review before submission: SIRS, SHUV

DECLARATIONS OF INTEREST
None known

Drugs for the prevention and treatment of pruritus in patients receiving neuraxial opioids (Protocol) 9
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.