Prophylactic ondansetron does not reduce the incidence of itching induced by intrathecal sufentanil

  • Beverly Waxler
  • Shirley A. Mondragon
  • Sonal N. Patel
  • Kochuthresia Nedumgottil
Regional Anesthesia and Pain

Abstract

Purpose

Postoperative itching after intrathecal (IT) narcotics may be a difficult and important problem for both the anesthesiologist and the patient in the postanesthetic care unit. Since some studies have reported success in preventing itching with ondansetron, we designed a prospective, randomized, double-blinded, and controlled study to test whether prophylactic iv ondansetron effectively reduces the incidence of IT sufentanil-induced pruritus.

Methods

Thirty-four patients (ASA I-III, age 18–74 yr) underwent ambulatory surgery after spinal anesthesia with IT lidocaine (15-100 mg) and IT sufentanil (10 μg). The patients were randomized into two groups to receiveiv either 4 mL saline (n = 13) or 8 mg ondansetron (n = 21) before the IT injection. The incidence of pruritus and other variables was recorded. Pruritus scores were obtained with a verbal analogue score with 0 meaning none and 10 the worst itching that the patient could imagine. Statistical difference was assumed if P < 0.05.

Results

Ondansetron did not reduce the incidence of pruritus (77vs 81%) compared to placebo (P = 1.000). The pruritus scores (4.4 vs 3.6) of the two groups were not significantly different (P =0.670).

Conclusions

There are contradictory findings in the literature regarding the effectiveness of ondansetron in preventing narcotic-induced itching. Although some studies have indicated that ondansetron could prevent this side effect of IT narcotics, a recent report suggested that ondansetron is not effective in preventing narcotic-induced itching (sufentanil-morphine) after a Cesarean section. In the present study we obtained similar, negative results.

L’administration prophylactique d’ondansétron ne réduit pas l’incidence de prurit induit par le sufentanil intrathécal

Résumé

Objectif

Le prurit postopératoire induit par l’administration intrathécaie (IT) de narcotiques est un problème important pour l’anesthésiologiste et le patient en salle de réveil. Certaines études ont montré que l’ondansétron prévenait le prurit. Notre étude prospective, randomisée, contrôlée et à double insu voulait vérifier si l’administration iv préventive d’ondansétron réduit effectivement l’incidence de prurit induit par le sufentanil IT.

Méthode

Trentequatre patients (ASA I–III, de 18 à 74 ans) ont subi une intervention chirurgicale ambulatoire sous rachianesthésie avec de la lidocaïne IT(15–100 mg) et du sufentanil IT(10μg). Lespatients, randomisée en deux groupes, ont reçu soit 4 mL de solution saline iv (n = 13), soit 8 mg d’ondansétron (n =21) avant l’injection IT L’incidence de prurit et d’autres variables a été notée. Les scores de prurit ont été obtenus par une échelle verbale analogique où 0 n’indiquait aucun prurit et 10, le pire prurit imaginable. On supposait une différence statistique si P < 0,05.

Résultats

Londansétron, comparé au placebo, n’a pas réduit l’incidence de prurit (77 vs 81 %, P = 1,000). Le prurit (4,4 vs 3,6) des patients des deux groupes n’était pas significativement différent (P =0,670).

Conclusion

Des résultats contradictoires découlent de publications sur l’efficacité de l’ondansétron dans la prévention du prurit induit par les narcotiques. Certaines études ont indiqué que l’ondansétron pouvait prévenir cet effet secondaire des narcotiques IT, mais un article récent montre qu’il n’est pas efficace (avec sufentanilmorphine) après une césarienne. Nos résultats négatifs sont similaires.

References

  1. 1.
    Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth 1995; 42: 891–903.PubMedCrossRefGoogle Scholar
  2. 2.
    Kam PC, Tan KH. Pruritus-itching for a cause and relief? Anaesthesia 1996; 51: 1133–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Szarvas S, Harmon D, Murphy D. Neuraxial opioid-induced pruritus: a review. J Clin Anesth 2003; 15: 234–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Waxier B, Mondragon S, Patel S, Nedumgottil K. Intrathecal lidocaine and sufentanil shorten postoperative recovery after outpatient rectal surgery. Can J Anesth 2004; 51: ===.Google Scholar
  5. 5.
    Ko MC, Naughton NN. An experimental itch model in monkeys. Characterization of the intrathecal morphine-induced scratching and antinociception. Anesthesiology 2000; 92: 795–805.PubMedCrossRefGoogle Scholar
  6. 6.
    Borgeat A, Stirnemann HR. Ondansetron is effective to treat spinal or epidural morphine-induced pruritus. Anesthesiology 1999; 90: 432–6.PubMedCrossRefGoogle Scholar
  7. 7.
    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
  8. 8.
    Gurkan Y, Toker K. Prophylactic ondansetron reduces the incidence of intrathecal fentanyl-induced pruritus. Anesth Analg 2002; 95: 1763–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Thomas DA, Williams GM, Iwata K, Kenshalo DR Jr, Dubner R. Multiple effects of morphine on facial scratching in monkeys. Anesth Analg 1993;77: 933–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Thomas DA, Williams GM, Iwata K, Kenshalo DR Jr, Dubner R. The medullary dorsal horn. A site of action of morphine in producing facial scratching in monkeys. Anesthesiology 1993; 79: 548–54.PubMedCrossRefGoogle Scholar
  11. 11.
    Hamon M, Gallissot MC, Menard F, Gozlan H, Bourgoin S, Verge D. 5-HT3 receptor binding sites are capsaicin-sensitive fibres in the rat spinal cord. Eur J Pharmacol 1989; 164: 315–22.PubMedCrossRefGoogle Scholar
  12. 12.
    Waeber C, Dixon K, Hoyer D, Palacios JM. Localisation by autoradiography of neuronal 5-HT3 receptors in the mouse CNS. Eur J Pharmacol 1988; 151: 351–2.PubMedCrossRefGoogle Scholar
  13. 13.
    Scott PV, Fischer HB. Spinal opiate analgesia and facial pruritus: a neural theory. Postgrad Med J 1982; 58: 531–5.PubMedGoogle Scholar
  14. 14.
    Andrew D, Craig AD. Spinothalamic lamina I neurons selectively sensitive to histamine: a central neurol pathway for itch. Nat Neurosci 2001; 4: 72–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Ben-David B, DeMeo PJ, Lucyk C, Solosko D. Minidose lidocaine-fentanyl spinal anesthesia in ambulatory surgery: prophylactic nalbuphine versus nalbuphine plus droperidol. Anesth Analg 2002; 95: 1596–600.PubMedCrossRefGoogle Scholar
  16. 16.
    Yazigi A, Chalhoub V, Madi-Jebara S, Haddad F, Hayek G. Prophylactic ondansetron is effective in the treatment of nausea and vomiting but not on pruritus after cesarean delivery with intrathecal sufentanil-morphine. J Clin Anesth 2002; 14: 183–6.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  • Beverly Waxler
    • 1
  • Shirley A. Mondragon
    • 1
  • Sonal N. Patel
    • 1
  • Kochuthresia Nedumgottil
    • 1
  1. 1.Division of Postanesthesia Care, Department of Anesthesiology and Pain ManagementJohn H. Stroger Jr. Hospital of Cook CountyChicagoUSA

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