Ondansetron and tropisetron do not prevent intraspinal morphine- and fentanyl-induced pruritus in elective cesarean delivery.

Abstract

BACKGROUND:

Although intraspinal morphine has been shown to be effective in providing analgesia after cesarean delivery, pruritus as a side-effect remains a common cause of dissatisfaction. The role of ondansetron has been studied in preventing pruritus but the results have been contradictory.

METHODS:

We randomized 98 parturients undergoing elective cesarean section using combined spinal-epidural anesthesia into a double-blinded trial to receive tropisetron 5 mg (T group) or ondansetron 8 mg (O group) or placebo (NaCl group) after delivery, when intrathecal morphine 160 microg and fentanyl 15 microg were used for post-operative pain control. The patients additionally received ketoprofen 300 mg per day. Post-operative itching, nausea and vomiting, sedation and need for rescue analgesics were registered every 3 h up to 24 h, and all patients were interviewed on the first post-operative day.

RESULTS:

Seventy-six percent of the parturients in the placebo group, 87% in the ondansetron, and 79% in the tropisetron group had itching. The incidence of post-operative nausea and vomiting was 21%, 20% and 11% of the patients in the placebo, ondansetron and tropisetron groups, respectively. Medication for pruritus was needed by 31%, 23% and 39% of the patients in the placebo, ondansetron and tropisetron groups, respectively. In the post-operative questionnaire, the patients reported less post-operative nausea in the tropisetron group than in the placebo group (P < 0.01).

CONCLUSION:

Neither ondansetron nor tropisetron prevent itching caused by intrathecal morphine with fentanyl. However, tropisetron reduced post-operative nausea.

• Authors: P J Sarvela, P M Halonen, A I Soikkeli, J P Kainu, K T Korttila
• Journal: Acta anaesthesiologica Scandinavica (Acta Anaesthesiol Scand) Vol. 50 Issue 2 Pg. 239-44 (Feb 2006) ISSN: 0001-5172 [Print] England
• PMID: 16430549 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Analgesics, Opioid
• Anti-Inflammatory Agents, Non-Steroidal
• Antiemetics
• Indoles
• Ondansetron
• Tropisetron
• Morphine
• Ketoprofen
• Fentanyl

Topics

• Adult
• Analgesics, Opioid (administration & dosage, adverse effects)
• Anesthesia, Epidural (methods)
• Anesthesia, Spinal (methods)
• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage)
• Antiemetics (administration & dosage, therapeutic use)
• Cesarean Section (methods)
• Double-Blind Method
• Elective Surgical Procedures (methods)
• Female
• Fentanyl (administration & dosage, adverse effects)
• Humans
• Indoles (administration & dosage, therapeutic use)
• Injections, Spinal (methods)
• Ketoprofen (administration & dosage)
• Morphine (administration & dosage, adverse effects)
• Ondansetron (administration & dosage, therapeutic use)
• Pain, Postoperative (prevention & control)
• Postoperative Nausea and Vomiting (prevention & control)
• Pregnancy
• Prospective Studies
• Pruritus (chemically induced)
• Time Factors
• Treatment Outcome
• Tropisetron