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 METHODS
agonist-antagonists, 5-HT3 -receptor antagonists, dopamine D2 -
receptor antagonists, H1 -receptor antagonists, catecholamines, in-
ductive agents such as propofol, and steroidal and nonsteroidal Criteria for considering studies for this review
inflammatory drugs. Besides the different groups of drugs used,
the dosage and route of administration of each drug have also been
studied.
Types of studies
The evidence supporting the use of each group of drugs is con- We will include randomized controlled trials (RCTs) that compare
flicting. The opioid antagonist naloxone appears to give good re- any drug with active or inactive control to prevent or reduce the
sults in preventing and treating neuraxial opioid-induced pruritus severity of pruritus in patients receiving spinal or epidural opioids.
(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 Types of participants
also reverses the analgesic effect of the opioid; therefore, opioid ag- We will include all patients receiving neuraxial opioids and other
onist-antagonists might do better. Nalbuphine has demonstrated drugs that may decrease the incidence or severity of pruritus.
good results in treating opioid-induced pruritis (Charuluxananan We will exclude all patients with pre-existing pruritus or pruritus
2001) while epidural butorphanol may or may not prevent spinal risk before receiving neuraxial opioids.
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- Types of interventions
tion frequencies, with varying efficacies. Ondansetron has been Our experimental intervention will be any drug given before the
reported to be effective in treating neuraxial opioid-induced pru- onset of pruritus compared with placebo, no treatment, or another
ritus (Borgeat 1999; Charuluxananan 2000). Five 4 mg postoper- drug.
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 Types of outcome measures
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 Primary outcomes
neuraxial opioid-induced pruritus (Lee 2007). Our primary outcomes are:
1. incidence of pruritus;
2. severity of pruritus.
Several review articles and one systematic review have been pub-
lished on pharmacological prevention of spinal or epidural opioid- Secondary outcomes
induced pruritus (Kjellberg 2001; Rathmell 2005; Szarvas 2003).
However, many new drugs such as granisetron, dolasetron and Our secondary outcomes are:
alzapride were not included in these reviews. Therefore we intend 1. number of patient who had significant changes in sedation
to update the clinical information on drugs for the prevention and score;
2. number of patient who had significant changes in pain
treatment of neuraxial opioid-induced pruritus.
score;
3. other side effects such as dizziness or pain on injection.

OBJECTIVES
Search methods for identification of studies
The objective of this review is to evaluate the efficacy and safety
of drugs for preventing or treating pruritus in patients receiving
neuraxial opioids.
Electronic searches
We will evaluate whether drugs given prior to or after onset of We will search the Cochrane Central Register of Controlled Trials
pruritus alter the risks of pruritus and other side-effects (somno- (CENTRAL) (The Cochrane Library, current issue); Silver Platter
lence, increased analgesic requirement) in patients receiving spinal MEDLINE (WebSPIRS) (1950 to present); EMBASE (1988 to
or epidural opioids. present); LILACS (1992 to present).

Drugs for the prevention and treatment of pruritus in patients receiving neuraxial opioids (Protocol) 2
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Our searches will be reported in the appendices: CENTRAL ( random numbers or other description that contained elements
Appendix 1); MEDLINE (Appendix 2); EMBASE (Appendix 3); indicating no concealment of allocation
LILACS (Appendix 4). 3. Blinding to treatment and outcome assessment;
We will search for relevant ongoing trials in specific web sites: 4. Completeness of follow up.
1. http://www.controlled-trials.com; We will discuss the impact of methodological quality on the results.
2. http://www.update-software.com. We will perform a sensitivity analysis by either including or ex-
We will combine the MEDLINE search strategy with the cluding categories B and C from the meta-analysis.
Cochrane ’Highly sensitive search strategy, phases one and two’ as
contained in the Cochrane Handbook for Systematic Reviews of
Interventions (Higgins 2005). Data extraction
We will check the reference list of relevant articles. Two authors (SIRS and SHUV) will independently extract data
We will not apply a language restriction. using a standardized checklist.
We will identify trials by handsearching abstracts of relevant con- We will resolve any disagreement through consultation with the
ference proceedings. third author (SUWS).

Data collection and analysis Statistics

We will quantitatively review the included data and combine it
by intervention, outcome, and population using The Cochrane
Trial Identification Collaboration’s statistical software (RevMan 5.0).
Two authors (SIRS and SHUV) will independently scan the titles We will estimate the overall effects by meta-analysis if data are
and abstracts of reports identified by electronic searching, manual available and trials are sufficiently similar. For dichotomous out-
searching, and snowballing. comes, we will calculate the relative risk (RR), the odds ratio (OR),
We will retrieve and evaluate potentially relevant studies, chosen and their respective 95% confidence intervals (CI). For continuous
by at least one author, in full-text versions. 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-
Trial selection gether with their respective 95% confidence intervals (CIs).
Two authors (SIRS and SHUV) will independently select trials We will test statistical heterogeneity by the Q test (P value < 0.1)
that meet the inclusion criteria using a checklist designed in ad- and I-squared (I2 ) test (I2 > 50%) (Higgins 2002). We will pool
vance for that purpose. clinically and statistically homogeneous studies using the fixed-
The third author (SUWS) will settle any disagreements. 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
Quality assessment subgroup and sensitivity analyses if there are sufficient studies and
We will judge the study quality on the basis of the following. data:
1. Method of randomization. • pregnant or general patient;
2. Method of allocation concealment, where • sensitivity analysis based on quality of allocation
i) low risk of bias; adequate allocation concealment with concealment.
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
ACKNOWLEDGEMENTS
containing elements suggesting adequate concealment;
ii) high risk of bias; unclear allocation concealment in We would like to thank Dr Jane Ballantyne (content editor); Dr
which the authors either did not report an allocation Martin Schmelz, Dr Vector Pace, and Dr Thomas Schricker (peer
concealment approach at all, or reported an approach that did reviewers); and Anne Lyddiat (consumer) for their help and ed-
not fall into category A, or that indicated inadequate allocation itorial advice during the preparation of this protocol. We would
concealment (e.g. alternation or reference to case numbers or also like to thank Karen Hovhannisyan for his help in writing the
dates of birth) search strategy and process. Our appreciation also goes to Jane
iii) no allocation concealment used; any procedure that Cracknell for co-ordinating this protocol and to Janet Wale for
was entirely transparent before allocation (e.g. an open list of copy editing the protocol.

Drugs for the prevention and treatment of pruritus in patients receiving neuraxial opioids (Protocol) 3
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
 REFERENCES

Additional references Gwirtz 1999

Gwirtz KH, Young JV, Byers RS, Alley C, Levin K,
Alhashemi 1997 Walker SG, et al. The safety and efficacy of intrathecal
Alhashemi JA, Crosby ET, Grodecki W, Duffy PJ, Hull opioid analgesia for acute postoperative pain: seven years’
KA, Gallant C. Treatment of intrathecal morphine-induced experience with 5969 surgical patients at Indiana University
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Anaesthesia 1997;44(10):1060–5.
Herman 1999
Ballantyne 1988 Herman NL, Choi KC, Affleck PJ, Calicott R, Brackin
Ballantyne JC, Loach AB, Carr CB. Itching after epidural
R, Singhal A, et al. Analgesia, pruritus, and ventilation
and spinal opiates. Pain 1988;33(2):149–60. exhibit a dose-response relationship in parturients receiving
Behar 1979 intrathecal fentanyl during labor. Anesthesia and Analgesia
Behar M, Magora F, Olshwang D, Davidson JT. Epidural 1999;89(2):378–83.
morphine in treatment of pain. Lancet 1979;1(8115):
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Borgeat 1999 meta-analysis. Statistics in Medicine 2002;21(11):1539–58.
Borgeat A, Stirnemann HR. Ondansetron is effective
to treat spinal or epidural morphine induced pruritus. Higgins 2005
Anesthesiology 1999;90(2):432–6. Higgins JPT, Green S, editors.Cochrane Handbook for
Systematic Reviews of Interventions 4.2.2 [updated March
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Charuluxananan S, Somboonviboon W, Kuokong O,
Nimcharoendee K. Ondansetron for treatment of intrathecal Hu 1981
morphine-induced pruritus after cesarean delivery. Regional Hu JW, Dostrovsky JO, Sessle BJ. Functional properties of
Anesthesia and Pain Medicine 2000;25(5):535–9. neurons in cat trigeminal subnucleus caudalis (medullary
dorsal horn). I. Responses to oral-facial noxious and
Choi 2000
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Choi JH, Lee J, Choi JH, Bishop MJ. Epidural naloxone
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Anaesthesia 2000;47(1):33–7. Kjellberg 2001
Dimitriou 1999 Kjellberg F, Tramer MR. Pharmacological control of
opioids-induced pruritus: a quantitative systematic review
Dimitriou V, Voyagis GS. Opioid-induced pruritus:
repeated vs single dose ondansetron administration in of randomized controlled trials. European Journal of
Anaesthesiology 2001;18(6):346–57.
preventing pruritus after intrathecal morphine. British
Journal of Anaesthesia 1999;83(5):822–3. Ko 2003
Fuller 1990 Ko MCH, Lee H, Song MS, Sobczyk-Kojiro K, Mosberg
Fuller JG, McMorland GH, Douglas MJ, Palmer L. HI, Kishioka S, et al. Activation of k-opioid receptors
Epidural morphine for analgesia after caesarean section: a inhibits pruritus evoked by subcutaneous or intrathecal
report of 4880 patients. Canadian Journal Anaesthesia 1990; administration of morphine in monkeys. The Journal of
37(6):636–40. Pharmacology and Experimental Therapeutics 2003;305(1):
173–9.
Gambling 1994
Gambling DR, Howell P, Huber C, Kozak S. Epidural Lane 2005
butorphanol does not reduce side effects from epidural Lane S, Evans P, Arfeen Z, Misra U. A comparison of
morphine after cesarean birth. Anesthesia and Analgesia intrathecal fentanyl and diamorphine as adjuncts in spinal
1994;78(6):1099–104. anaesthesia for caesarean section. Anaesthesia 2005;60(5):
453–7.
Gedney 1998
Gedney JA, Liu EHC. Side-effects of epidural infusions of Lawhorn 1991
opioids bupivacaine mixtures. Anaesthesia 1998;53(12): Lawhorn CD, McNitt JD, Fibuch EE, Joyce JT, Leadley RJ
1148–55. Jr. Epidural morphine with butorphanol for postoperative
Gowan 1988 analgesia after cesarean delivery. Anesthsia and Analgesia
Gowan JD, Hurtig JB, Fraser RA, Torbicki E, Kitts J. 1991;72(1):53–7.
Naloxone infusion after prophylactic epidural morphine: Lee 2007
effects on incidence of postoperative side-effects and quality Lee H, Naughton NN, Woods JH, Ko MC. Effects of
of analgesia. Canadian Journal of Anaesthesia 1988;35(2): butorphanol on morphine-induced itch and analgesia in
143–8. primates. Anesthesiology 2007;107(3):478–85.
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Lockington 2007 Scott 1982
Lockington PF, Fa’aea P. Subcutaneous naloxone for the Scott PV, Fischer HBJ. Intraspinal opiates and itching: a
prevention of intrathecal morphine induced pruritus in new reflex?. BMJ 1982;284(6321):1015–6.
elective caesarean delivery. Anaesthesia 2007;62(7):672–6. Shah 2000
Nelson 2002 Shah MK, Sia AT, Chong JL. The effect of the addition
Nelson KE, Rauch T, Terebuh V, D’Angelo R. A comparison of ropivacaine or bupivacaine upon pruritus induced by
of intrathecal fentanyl and sufentanil for labor analgesia. intrathecal fentanyl in labour. Anaesthesia 2000;55(10):
Anesthesiology 2002;96(5):1070–3. 1008–13.
Rathmell 2005 Szarvas 2003
Rathmell JP, Lair TR, Nauman B. The role of intrathecal Szarvas S, Harmon D, Murphy D. Neuraxial opioid-
drugs in the treatment of acute pain. Anesthesia and induced pruritus: a review. Journal of Clinical Anesthesia
Analgesia 2005;101(2 Suppl):30–43. 2003;15(3):234–9.
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2007. ∗
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
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(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.