Journal of Anesthesia

, Volume 21, Issue 2, pp 159–163 | Cite as

Lornoxicam and ondansetron for the prevention of intrathecal fentanyl-induced pruritus

  • Nurcin Gulhas
  • Feray Akgul Erdil
  • Ozlem Sagir
  • Ender Gedik
  • Turkan Togal
  • Zekine Begec
  • M. Ozcan Ersoy
Original articles



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.


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.


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.


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.

Key words

Intrathecal Fentanyl Pruritus Ondansetron Lornoxicam 


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  1. 1.
    Szarvas, S, Harmon, D, Murphy, D 2003Neuraxial opioid-induced pruritus: a reviewJ Clin Anesth15234239PubMedCrossRefGoogle Scholar
  2. 2.
    Waxler, B, Dadabhoy, ZP, Stojiljkovic, L, Rabito, S 2005Primer of postoperative pruritus for anesthesiologistsAnesthesiology103168178PubMedCrossRefGoogle Scholar
  3. 3.
    Colbert, S, Hanlon, DMO, Galvin, S, Chambers, F, Moriarty, DC 1999The effect of rectal diclofenac on pruritus in patients receiving intrathecal morphineAnaesthesia54948952PubMedCrossRefGoogle Scholar
  4. 4.
    Colbert, S, Hanlon, DMO, Chambers, F, Moriarty, DC 1999The effect of intravenous tenoxicam on pruritus in patients receiving epidural fentanylAnaesthesia547680PubMedCrossRefGoogle Scholar
  5. 5.
    Elhakm, M, Nafie, M 1995IV tenoxicam for analgesia during cesarean sectionBr J Anaesth74643646CrossRefGoogle Scholar
  6. 6.
    Rosenow, DE, Krieken, FV, Stolke, D, Kursten, FW 1996Intravenous administration of lornoxicam, a new NSAID, and pethidine for postoperative painClin Drug Invest111119CrossRefGoogle Scholar
  7. 7.
    Radhofer-Welte, S, Rbasseda, X 2000Lornoxicam, a new potent NSAID with an improved tolerability profileDrugs of Today365576PubMedGoogle Scholar
  8. 8.
    Carvalho, B, Durbin, M, Draver, DR, Cohen, SE, Ginosar, Y, Riley, ET 2005The ED50 and ED95 of intrathecal isobaric bupivacaine with opioids for cesarean deliveryAnesthesiology103606612PubMedCrossRefGoogle Scholar
  9. 9.
    Bogra, J, Arora, N, Srivastava, P 2005Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean sectionBMC Anesthesiology515CrossRefGoogle Scholar
  10. 10.
    Sarvela, PJ, Halonen, PM, Soikkeli, AI, Kainu, JP, Korttila, KT 2006Ondansetron and tropisetron do not prevent intraspinal morphine- and fentanyl-induced pruritus in elective cesarean deliveryActa Anaesthesiol Scand50239244PubMedCrossRefGoogle Scholar
  11. 11.
    Kimoto, M, Murao, K, Shirane, A, Sakamoto, S, Yamada, M, Nakao, S, Shingu, K 2005Appropriate dose of isobaric bupivacaine with fentanyl in spinal anesthesia for Cesarean sectionMasui (Jpn J Anesthesiol)54864868Google Scholar
  12. 12.
    Teoh, WHL, Thomas, E, Tan, HM 2006Ultra-low dose combined spinal-epidural anesthesia with intrathecal bupivacaine 3.75 mg for cesarean sectionInt Obstet Anesth15273278CrossRefGoogle Scholar
  13. 13.
    Korhonen, AM, Valanne, JV, Jokela, RM, Ravaska, P, Korttila, K 2003Ondansetron does not prevent pruritus induced by low dose intrathecal fentanylActa Anaesthesiol Scand4712921297PubMedCrossRefGoogle Scholar
  14. 14.
    Conkln, KA, Backus, AM 1999

    Physiologic changes of pregnancy

    Chestnut DH Obstetric anesthesia2nd ednMosbySt. Louis25
    Google Scholar
  15. 15.
    Anderson, GD 2005Pregnancy-induced changes in pharmacokinetics: a mechanistic-based approachClin Pharmacokinet449891008PubMedCrossRefGoogle Scholar
  16. 16.
    Gurkan, Y, Toker, K 2002Prophylactic ondansetron reduces the incidence of intrathecal fentanyl-induced pruritusAnesth Analg9517631766PubMedCrossRefGoogle Scholar
  17. 17.
    Yeh, HM, Chen, LK, Lin, CJ, Chan, WH, Chen, YP, Lin, CS, Sun, WZ, Wang, MJ, Tsai, SK 2000Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing Cesarean deliveryAnesth Analg917275CrossRefGoogle Scholar
  18. 18.
    Charuluxananan, S, Somboonviboon, W, Kyokong, O, Nimcharoendee, K 2000Ondansetron for treatment of intrathecal morphine-induced pruritus after cesarean deliveryReg Anesth Pain Med25535539PubMedCrossRefGoogle Scholar
  19. 19.
    Yazigi, A, Chalhoub, V, Madi-Jebara, S, Haddad, F, Hayek, G 2002Prophylactic ondansetron is effective in the treatment of nausea and vomiting but not on pruritus after cesarean delivery with intrathecal sufentanil-morphineJ Clin Anesth14183186PubMedCrossRefGoogle Scholar

Copyright information

© JSA 2007

Authors and Affiliations

  • Nurcin Gulhas
    • 1
  • Feray Akgul Erdil
    • 1
  • Ozlem Sagir
    • 1
  • Ender Gedik
    • 1
  • Turkan Togal
    • 1
  • Zekine Begec
    • 1
  • M. Ozcan Ersoy
    • 1
  1. 1.Department of AnesthesiologyInonu University School of MedicineMalatyaTurkey

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