Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus and post-operative nausea and vomiting in patients undergoing caesarean section (original) (raw)
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Anesthesia & Analgesia, 2004
mg vs 0.1 mg), and different scales of pruritus and nauseavomiting scales (4-point scale versus 3-point scale). We agree that the serotonin receptors in the spinal cord were probably activated by sufentanil before they were blocked by ondansetron, which may be the reason of failure of ondansetron for prevention of pruritus in his study. Although in our study there was no statistical significant difference in the severity of nauseavomiting, the percentage of patients with severe nausea or vomiting (nausea-vomiting score 3, 4) of 4 mg nalbuphine, 4 mg ondansetron, 8 mg ondansetron, and placebo were 15%, 8%, 9% and 24%, respectively (P ϭ 0.053), which showed the tendency of prophylactic efficacy of nausea and vomiting. Moreover, the prophylactic success rate of nausea-vomiting by ondansetron in our study and Yazigi et al.'s study were comparable (81% vs 82%). Therefore, more data or more valid trials are needed.
Acta Anaesthesiologica Scandinavica, 2010
Background: Subarachnoid (SA) morphine, highly effective for the management of pain after a cesarean delivery, is associated with a significant incidence of pruritus in up to 80% of patients. No previous study has compared the effectiveness of ondansetron (5-HT 3 antagonist) vs. diphenhydramine (H 1 receptor blocker) for the treatment of this side effect. Methods: In this randomized, double-blind study, 113 patients with a pruritus score 3 or 4 (1 5 absent; 2 5 mild, no treatment required; 3 5 moderate pruritus, treatment required; and 4 5 severe pruritus) after SA morphine 0.2 mg were assigned to group ondansetron, which received 4 mg intravenously (i.v.) ondansetron, and group diphenhydramine, which received 25 mg i.v. diphenhydramine. Patients who continued to have pruritus ! 3 30 min after the study drug were considered treatment failures and were treated with naloxone 0.04 mg i.v. repeatedly, as well as patients who relapsed. Pain scores, nausea, vomiting, and sedation were determined before and 30 min after the study drugs were administered. Patients were followed up for 24 h.
Anesthesia: Essays and Researches, 2016
Background: Intrathecal morphine provides effective postoperative analgesia, but their use is associated with numerous side effects, including pruritus, nausea, vomiting, urinary retention, and respiratory depression. Pruritus is the most common side effect with a reported incidence of 58-85%. Objectives: This prospective, randomized, and double-blinded study was performed for women scheduled for cesarean delivery using spinal anesthesia to compare nalbuphine and ondansetron in the prevention of intrathecal morphine-induced pruritus. Patients and Methods: Ninety women after spinal anesthesia with hyperbaric bupivacaine and intrathecal morphine patients randomly divided into three groups. Women in placebo group (P group) received 4 ml of normal saline intravenous (IV) injection, nalbuphine group (N group) received 4 ml of a 4 mg nalbuphine IV injection, and ondansetron 4 group (O group) received 4 ml of a 4 mg ondansetron IV injection, immediately after delivery of the baby. Studied women observed in postanesthesia care unit for 4 h. The primary outcome measures success of the treatment, defined as a pruritus score 1 (no pruritus) or 2 (mild pruritus-no treatment required) at 20 min after treatment. Results: Although, three was no significant difference between the three studied groups regarding; score 1 pruritus, while, score 2 pruritus (mild pruritus-no treatment requested) was significantly high in N and O groups compared to placebo group. Pruritus score 1 (no pruritus) plus pruritus score 2 were significantly high in N and O groups compared to placebo group (20 cases, 20 cases, 5 cases; respectively, P = 0.008). In addition; score 3 pruritus (moderate-treatment requested) was significantly less in N and O groups
Ondansetron and Metoclopramide Can Prevent Intrathecal Sufentanil-Induced Pruritus
2018
Background: We have compared the effectiveness of metoclopramide and ondansetron in the prevention of pruritus caused by intrathecal injection of sufentanil in parturients undergoing elective caesarean section under spinal anesthesia. Methods: 123 parturients ASA I & II divided in to 3 groups with random allocation software, with 41 parturient in each group. Spinal anesthesia was performed with 2 ml of bupivacaine 0.5% plus 2.5 microgram sufentanil. The first group received 4mg of ondansetron, the second group 10mg of metoclopramide and the third group placebo, immediately after clamping of the umbilical cord. During surgery and postoperative period, the parturients were assessed for hemodynamic changes, pruritus, nausea and vomiting and shivering. Results: There were significant differences in the incidence of pruritus among three groups. The incidence of moderate pruritus was significantly higher in control group (47.5%) in comparison with ondansetron (15.8%) and metoclopramide (1...
Anesthesia & Analgesia, 2005
Pruritus is the most common side effect of intrathecal morphine for postoperative pain relief. Activation of central 5-hydroxytryptamine subtype 3 (5-HT3) receptors is one of its possible mechanisms. The role of 5-HT3 antagonists in the prevention of pruritus has not been clearly established. In a prospective, randomized, double-blind, placebo-controlled study, we evaluated the efficacy of prophylactic administration of ondansetron and dolasetron for the prevention of intrathecal morphine-induced pruritus. The patients were randomized into 3 groups to receive either 4 mg ondansetron IV (group O, n ϭ 35), 12.5 mg dolasetron IV (group D, n ϭ 35) or 5 mL placebo (group P, n ϭ 35) 30 min before administration of spinal anesthesia with 10 to 17.5 mg of 0.5% hyperbaric bupivacaine and 0.25 mg of morphine for urologic, orthopedic, or vascular surgery.
Anesthesia & Analgesia, 2009
This review found that prophylactic serotonin (5-HT 3) receptor antagonists did not reduce pruritus incidence, but significantly reduced severity and need for pruritus treatment, postoperative nausea and vomiting and need for antiemetic therapy, and effectively treated established pruritus, in women who received intrathecal morphine for caesarean delivery. Methodological concerns and potential for missed studies made the reliability of the conclusions unclear. Searching MEDLINE (from 1966), EMBASE, Web of Science, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for publications in any language. The latest search was June 2008. Search terms were reported. Only full reports were considered; abstracts, letters and unpublished studies were excluded. The bibliography of each retrieved article and review was handsearched. Study selection Randomised controlled trials (RCTs) that compared prophylaxis or treatment using a serotonin (5-HT 3) receptor antagonist (ondansetron, granisetron, tropisetron and dolasetron) versus placebo in women who underwent caesarean delivery under spinal anaesthesia with standardised intrathecal morphine were eligible for inclusion. Eligible trials had to report the main endpoints of incidence of pruritus and/or nausea and/or vomiting in all study groups. Most of the included studies reported on prophylaxis against pruritus and/or nausea and vomiting, mostly with an observation period of 24 hours. No studies were of treatment of nausea and vomiting. Severity of nausea and vomiting was also assessed; studies used three different scales (details were provided). The 5-HT 3 receptor antagonists used in the included studies were ondansetron (4mg and 8mg), granisetron (1mg and 3mg) and tropisetron (5mg). Placebo was normal saline. Dose of intrathecal morphine ranged from 0.1mg to 0.2mg. Side effects were reported (such as headache). The authors did not state how many reviewers performed the selection. Assessment of study quality Methodological quality was assessed by two reviewers independently using the four-item seven-point Modified Oxford Scale. Any discrepancies were resolved by discussion with a third reviewer. Criteria used included: randomisation, allocation concealment, blinding and flow of patients. Methods of synthesis Relative risks were pooled using a fixed-effects model. Between-study heterogeneity was determined using Χ 2 test, I 2
Brazilian journal of anesthesiology (Elsevier)
The prophylactic effect of ondansetron on subarachnoid morphine-induced pruritus is controversial, while evidence suggests that droperidol prevents pruritus. The aim of this study is to compare the effects of droperidol and ondansetron on subarachnoid morphine-induced pruritus. 180 ASA I or II patients scheduled to undergo cesarean sections under subarachnoid anesthesia combined with morphine 0.2mg were randomized to receive, after the child's birth, metoclopramide 10mg (Group I - control), droperidol 2.5mg (Group II) or ondansetron 8mg (Group III). Postoperatively, the patients were assessed for pruritus (absent, mild, moderate or severe) or other side effects by blinded investigators. Patients were also blinded to their group allocation. The tendency to present more severe forms of pruritus was compared between groups. NNT was also determined. Patients assigned to receive droperidol [Proportional odds ratio: 0.45 (95% confidence interval 0.23-0.88)] reported less pruritus than...