Canadian Journal of Anesthesia

, 50:1023 | Cite as

Prophylacticiv ondansetron reduces nausea, vomiting and pruritus following epidural morphine for postoperative pain control

  • Jann-Inn Tzeng
  • Koung-Shing Chu
  • Shung-Tai Ho
  • Kuang-I Cheng
  • Kuo-Sheng Liu
  • Jhi-Joung Wang
Regional Anesthesia and Pain

Abstract

Purpose

To evaluate the prophylactic effect of ondansetron on nausea and vomiting following epidural morphine for postoperative pain control.

Methods

Seventy women (n = 35 in each group) undergoing abdominal total hysterectomy under epidural anesthesia were enrolled in this randomized, double-blinded, and placebo-controlled study. At the end of surgery, all patients received epidural morphine 3 mg for postoperative pain relief. Before morphine injection, the ondansetron group receivediv ondansetron 4 mg, whereas the placebo group received iv saline.

Results

Patients in the ondansetron group reported a lower frequency of total postoperative nausea and vomiting (22%) and lower frequency of rescue antiemetic request (12%) than those in the placebo group (52% and 39%, respectively;P < 0.05). In addition, ondansetron was associated with a reduced incidence of pruritus following epidural morphine (28% vs 58%;P < 0.05).

Conclusion

We conclude that iv ondansetron 4 mg is effective in the prevention of nausea, vomiting, and pruritus following epidural morphine for postoperative pain control.

L’administration prophylactique d’ondansétron iv réduit les nausées, les vomissements et le prurit qui suivent l’administration péridurale de morphine analgésique postopératoire

Résumé

Objectif

Évaluer l’effet prophylactique de l’ondansétron sur les nausées et les vomissements qui suivent l’administration péridurale de morphine analgésique postopératoire.

Méthode

Soixante-dix femmes (n = 35 dans chaque groupe) devant subir une hystérectomie abdominale totale sous anesthésie péridurale ont participé à l’étude randomisée, en double aveugle et contrôlée contre placebo. À la fin de l’opération, toutes les patientes ont reçu une analgésie péridurale avec 3 mg de morphine. Avant l’injection de la morphine, 4 mg d’ondansétron iv ont été administrés dans le groupe ondansétron et une solution saline dans le groupe placebo.

Résultats

Les patientes ayant reçu l’ondansétron ont présenté une plus faible fréquence de nausées et de vomissements postopératoires totaux (22 %) et ont demandé moins d’antiémétique de secours (12 %), comparées aux femmes du groupe placebo (52 % et 39 %, respectivement; P < 0,05). Aussi, l’ondansétron a été associé à une incidence réduite de prurit après l’administration péridurale de morphine (28 % vs 58%; P < 0,05).

Conclusion

L’administration iv de 4 mg d’ondansétron est efficace pour prévenir les nausées, les vomissements et le prurit qui suivent l’administration péridurale de morphine analgésique postopératoire.

References

  1. 1.
    Wolf H. Preclinical and clinical pharmacology of the 5-HT3 receptor antagonists. Scand J Rheumatol 2000; 29(Suppl): 37–45.CrossRefGoogle Scholar
  2. 2.
    Tyers MB. Pharmacology and preclinical antiemetic properties of ondansetron. Semin Oncol 1992; 19(Suppl 10): 1–8.PubMedGoogle Scholar
  3. 3.
    Cunningham RS. 5-HT3-receptor antagonists: a review of pharmacology and clinical efficacy. Oncol Nurs Forum 1997; 24: 33–40.PubMedGoogle Scholar
  4. 4.
    Gregory RE, Ettinger DS. 5-HT3 receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting. A comparison of their pharmacology and clinical efficacy. Drugs 1998; 55: 173–89.PubMedCrossRefGoogle Scholar
  5. 5.
    Maranzano E. Radiation-induced emesis: a problem with many open questions. Tumori 2001; 87: 213–8.PubMedGoogle Scholar
  6. 6.
    Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth 1995; 42: 891–903.PubMedCrossRefGoogle Scholar
  7. 7.
    Choi JH, Lee J, Choi JH, Bishop MJ. Epidural naloxone reduces pruritus and nausea without affecting analgesia by epidural morphine in bupivacaine. Can J Anesth 2000; 47: 33–7.PubMedGoogle Scholar
  8. 8.
    Ho ST, Wang JJ, Tzeng JI, Liu HS, Ger LP, Liaw WJ. Dexamethasone for preventing nausea and vomiting associated with epidural morphine: a dose-ranging study. Anesth Analg 2001; 92: 745–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Tzeng JL, Wang JJ, Ho ST, Tang CS, Liu YC, Lee SC. Dexamethasone for prophylaxis of nausea and vomiting after epidural morphine for post-caesarean section analgesia: comparison of droperidol and saline. Br J Anaesth 2000; 85: 865–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Lerman J. Study design in clinical research: sample size estimation and power analysis. Can J Anaesth 1996; 43: 184–91.PubMedGoogle Scholar
  11. 11.
    Higgins GA, Kilpatrick GJ, Bunce KT, Jones BJ, Tyers MB. 5-HT3 receptor antagonists injected into the area postrema inhibit cisplatin-induced emesis in the ferret. Br J Pharmacol 1989; 97: 247–55.PubMedGoogle Scholar
  12. 12.
    Ye JH, Ponnudurai R, Schaefer R. Ondansetron: a selective 5-HT3 receptor antagonist and its applications in CNS-related disorders. CNS Drug Reviews 2001; 7: 199–213.PubMedGoogle Scholar
  13. 13.
    Ballantyne JC, Loach AB, Carr DB. Itching after epidural and spinal opiates. Pain 1988; 33: 149–60.PubMedCrossRefGoogle Scholar
  14. 14.
    Charuluxananan S, Somboonviboon W, Kyokong O, Nimcharoendee K. Ondansetron for treatment of intrathecal morphine-induced pruritus after cesarean delivery. Reg Anesth Pain Med 2000; 25: 535–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Teh HM, Chen LK, Lin CJ, et al. Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. Anesth Analg 2000; 91: 172–5.CrossRefGoogle Scholar
  16. 16.
    Borgeat A, Stirnemann HR. Ondansetron is effective to treat spinal or epidural morphine-induced pruritus. Anesthesiology 1999; 90: 432–6.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2003

Authors and Affiliations

  • Jann-Inn Tzeng
    • 1
    • 2
  • Koung-Shing Chu
    • 1
  • Shung-Tai Ho
    • 3
  • Kuang-I Cheng
    • 1
  • Kuo-Sheng Liu
    • 1
  • Jhi-Joung Wang
    • 1
    • 2
  1. 1.Department of AnesthesiologyChi-Mei Medical CenterTainanTaiwan
  2. 2.Department of AnesthesiologyChi-Mei Medical CenterTainan
  3. 3.Department of AnesthesiologyTri-Service General HospitalTaipeiTaiwan

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