AANA journal
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Meta Analysis
Use of Nalbuphine for Treatment of Neuraxial Opioid-Induced Pruritus: A Systematic Review and Meta-Analysis.
Opioid-induced pruritus is prevalent after neuraxial administration of opioid. A number of preventive measures have been reported; however, only a few studies evaluated treatment strategies for established pruritus. The pharmacokinetics and pharmacodynamic profiles of nalbuphine make this drug ideal for the treatment of established pruritus. ⋯ There was a low quality of evidence that nalbuphine was effective in reducing the incidence of pruritus compared with active control (RR, 0.59; 95% CI, 0.38 to 0.93; P = .02). Conversely, there was no difference between the incidence of sedation (RR, 1.06; 95% CI, 0.42 to 2.71; P = .90) and postoperative nausea and vomiting (RR, 1.58, 95% CI, 0.75 to 3.31; P = .23). Although large studies are needed to decrease heterogeneity across studies, the current review showed that nalbuphine appears to reduce the incidence of opioid-induced pruritus.
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To date, researchers studying emergence delirium in adults have not adopted a consensus on the terminology for the phenomenon, a formalized definition, a measurement tool or standardized differential diagnosis to distinguish emergence delirium from postoperative delirium, anticholinergic or serotonergic toxicities, and other physiologic issues that may present on emergence from anesthesia. This lack of a consensus in emergence delirium research and differential diagnostic tools is confounding findings and preventing improved patient outcomes. Information from an integrative review of the literature in conjunction with a Delphi study was used to develop a standardized differential of similarly presenting phenomena to assist clinicians in determining appropriate interventions for patients who appear to have emergence delirium.