Abstract
Purpose
In this randomized, double-blind study, we aimed to compare the effectiveness of lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus in patients undergoing cesarean section.
Methods
One hundred and eight parturients (American Society of Anesthesiologists [ASA] I-II status) requesting neuraxial analgesia by a combined spinal-epidural (CSE) technique were recruited for this study. A CSE technique was performed and anesthesia was achieved with fentanyl 25 µg and hyperbaric bupivacaine 12 mg. Patients were randomly allocated to three groups, each with 36 participants. Immediately following delivery, patients received either lornoxicam 8 mg IV (group L; n = 36), ondansetron 8 mg IV (group O; n = 36), or normal saline 2 ml IV (group P; n = 36). Pruritus, pain, and nausea and vomiting scores were recorded during the initial 24 h postoperatively.
Results
The incidence of pruritus was significantly lower in group O from 4 to 12 h postoperatively when compared to that in group L and group P. According to the pruritus grading system we used, the number of patients without pruritus was significantly higher in group O when compared to that in group L and group P. The number of patients experiencing moderate pruritus was significantly lower in group O when compared to that in group P.
Conclusion
We observed that the administration of 8 mg IV lornoxicam failed to prevent intrathecal fentanyl-induced pruritus in parturients. Also, our data confirmed that ondansetron is likely to attenuate intrathecal fentanyl-induced pruritus.
Similar content being viewed by others
References
S Szarvas D Harmon D Murphy (2003) ArticleTitleNeuraxial opioid-induced pruritus: a review J Clin Anesth 15 234–239 Occurrence Handle12770663 Occurrence Handle10.1016/S0952-8180(02)00501-9 Occurrence Handle1:CAS:528:DC%2BD3sXktFGmu7c%3D
B Waxler ZP Dadabhoy L Stojiljkovic S Rabito (2005) ArticleTitlePrimer of postoperative pruritus for anesthesiologists Anesthesiology 103 168–178 Occurrence Handle15983470 Occurrence Handle10.1097/00000542-200507000-00025
S Colbert DMO Hanlon S Galvin F Chambers DC Moriarty (1999) ArticleTitleThe effect of rectal diclofenac on pruritus in patients receiving intrathecal morphine Anaesthesia 54 948–952 Occurrence Handle10540058 Occurrence Handle10.1046/j.1365-2044.1999.01066.x Occurrence Handle1:CAS:528:DyaK1MXmvFalurs%3D
S Colbert DMO Hanlon F Chambers DC Moriarty (1999) ArticleTitleThe effect of intravenous tenoxicam on pruritus in patients receiving epidural fentanyl Anaesthesia 54 76–80 Occurrence Handle10209375 Occurrence Handle10.1046/j.1365-2044.1999.00610.x Occurrence Handle1:CAS:528:DyaK1MXhtVeqtLg%3D
M Elhakm M Nafie (1995) ArticleTitleIV tenoxicam for analgesia during cesarean section Br J Anaesth 74 643–646 Occurrence Handle10.1093/bja/74.6.643
DE Rosenow FV Krieken D Stolke FW Kursten (1996) ArticleTitleIntravenous administration of lornoxicam, a new NSAID, and pethidine for postoperative pain Clin Drug Invest 11 11–19 Occurrence Handle1:CAS:528:DyaK28XhtVGgs7o%3D Occurrence Handle10.2165/00044011-199611010-00002
S Radhofer-Welte X Rbasseda (2000) ArticleTitleLornoxicam, a new potent NSAID with an improved tolerability profile Drugs of Today 36 55–76 Occurrence Handle12879104 Occurrence Handle1:CAS:528:DC%2BD3cXitVCmsr4%3D
B Carvalho M Durbin DR Draver SE Cohen Y Ginosar ET Riley (2005) ArticleTitleThe ED50 and ED95 of intrathecal isobaric bupivacaine with opioids for cesarean delivery Anesthesiology 103 606–612 Occurrence Handle16129987 Occurrence Handle10.1097/00000542-200509000-00025 Occurrence Handle1:CAS:528:DC%2BD2MXpsFeisr4%3D
J Bogra N Arora P Srivastava (2005) ArticleTitleSynergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section BMC Anesthesiology 5 1–5 Occurrence Handle10.1186/1471-2253-5-5 Occurrence Handle1:CAS:528:DC%2BD2MXltFamtbg%3D
PJ Sarvela PM Halonen AI Soikkeli JP Kainu KT Korttila (2006) ArticleTitleOndansetron and tropisetron do not prevent intraspinal morphine- and fentanyl-induced pruritus in elective cesarean delivery Acta Anaesthesiol Scand 50 239–244 Occurrence Handle16430549 Occurrence Handle10.1111/j.1399-6576.2006.00934.x Occurrence Handle1:CAS:528:DC%2BD28Xhs1KgsLc%3D
M Kimoto K Murao A Shirane S Sakamoto M Yamada S Nakao K Shingu (2005) ArticleTitleAppropriate dose of isobaric bupivacaine with fentanyl in spinal anesthesia for Cesarean section Masui (Jpn J Anesthesiol) 54 864–868
WHL Teoh E Thomas HM Tan (2006) ArticleTitleUltra-low dose combined spinal-epidural anesthesia with intrathecal bupivacaine 3.75 mg for cesarean section Int Obstet Anesth 15 273–278 Occurrence Handle10.1016/j.ijoa.2006.03.004 Occurrence Handle1:STN:280:DC%2BD28nptlGqsA%3D%3D
AM Korhonen JV Valanne RM Jokela P Ravaska K Korttila (2003) ArticleTitleOndansetron does not prevent pruritus induced by low dose intrathecal fentanyl Acta Anaesthesiol Scand 47 1292–1297 Occurrence Handle14616330 Occurrence Handle10.1046/j.1399-6576.2003.00206.x Occurrence Handle1:CAS:528:DC%2BD3sXhtVSqsL7P
KA Conkln AM Backus (1999) Physiologic changes of pregnancy Chestnut DH Obstetric anesthesia EditionNumber2nd edn Mosby St. Louis 25
GD Anderson (2005) ArticleTitlePregnancy-induced changes in pharmacokinetics: a mechanistic-based approach Clin Pharmacokinet 44 989–1008 Occurrence Handle16176115 Occurrence Handle10.2165/00003088-200544100-00001 Occurrence Handle1:CAS:528:DC%2BD2MXhtF2lu77J
Y Gurkan K Toker (2002) ArticleTitleProphylactic ondansetron reduces the incidence of intrathecal fentanyl-induced pruritus Anesth Analg 95 1763–1766 Occurrence Handle12456454 Occurrence Handle10.1097/00000539-200212000-00054 Occurrence Handle1:CAS:528:DC%2BD3sXltFajsg%3D%3D
HM Yeh LK Chen CJ Lin WH Chan YP Chen CS Lin WZ Sun MJ Wang SK Tsai (2000) ArticleTitleProphylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing Cesarean delivery Anesth Analg 91 72–75 Occurrence Handle10.1097/00000539-200007000-00032
S Charuluxananan W Somboonviboon O Kyokong K Nimcharoendee (2000) ArticleTitleOndansetron for treatment of intrathecal morphine-induced pruritus after cesarean delivery Reg Anesth Pain Med 25 535–539 Occurrence Handle11009242 Occurrence Handle10.1053/rapm.2000.7809 Occurrence Handle1:CAS:528:DC%2BD3cXnt1Kns78%3D
A Yazigi V Chalhoub S Madi-Jebara F Haddad G Hayek (2002) ArticleTitleProphylactic ondansetron is effective in the treatment of nausea and vomiting but not on pruritus after cesarean delivery with intrathecal sufentanil-morphine J Clin Anesth 14 183–186 Occurrence Handle12031749 Occurrence Handle10.1016/S0952-8180(01)00381-6 Occurrence Handle1:CAS:528:DC%2BD38XjvVels7s%3D
Author information
Authors and Affiliations
About this article
Cite this article
Gulhas, N., Erdil, F., Sagir, O. et al. Lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus. J Anesth 21, 159–163 (2007). https://doi.org/10.1007/s00540-007-0503-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-007-0503-4