Does Ondansetron or Granisetron Prevent Subarachnoid Morphine-Induced Pruritus After Cesarean Delivery?

Abstract

Neither prophylactic ondansetron nor granisetron reduced the incidence of subarachnoid morphine-induced pruritus when compared with the saline group.

A randomised comparison of regular oral oxycodone and intrathecal morphine for post-caesarean analgesia

“…Pruritus is the most frequent side effect of intrathecal morphine and the incidence in this study (87%) was consistent with previous research. 24 As expected, pruritus was less common and severe in the oral oxycodone group, possibly because of lower opioid concentrations in relevant central nervous areas following systemic administration.…”

Reduction of severity of pruritus after elective caesarean section under spinal anaesthesia with subarachnoid morphine: a randomised comparison of prophylactic granisetron and ondansetron

“…Unfortunately the incidence of pruritus in the obstetric population, especially after subarachnoid opioids, can be very high ranging between 70 and 93%. [4][5][6][7]9 This is consistent with our population among whom the incidence of pruritus in ondansetron and granisetron groups was 92.5% and 95% respectively. One of the possible mechanisms of pruritus is related to direct stimulation of 5-HT3 receptors by morphine in the dorsal horn of the spinal cord and medulla, therefore 5-HT3 antagonists may be beneficial in its treatment.…”

“…However, the overall incidence of pruritus has not been shown to be reduced with granisetron in patients undergoing caesarean section who received subarachnoid morphine. 9 Although the overall incidence of pruritus is not decreased, what is not clear is whether the prophylactic administration of a long acting 5-HT3 antagonist like granisetron reduces the severity of pruritus, thus improving maternal satisfaction. To our knowledge, no studies have been powered to detect a reduction in severity of pruritus with a long acting 5-HT3 antagonist.…”

Comparative safety of serotonin (5-HT3) receptor antagonists in patients undergoing surgery: a systematic review and network meta-analysis

“…2a. Twenty-one studies were excluded from the analysis because they reported zero events in all arms [39, 43, 57, 60, 61, 71, 73, 81, 82, 86, 90, 92–94, 98, 110, 121, 127, 145, 155, 156]. Although the definitions of arrhythmia varied across the studies (Additional file 1: Appendix 10), there was no evidence of network inconsistency ( χ 2 = 3.49, degrees of freedom = 10, P = 0.968, heterogeneity variance = 0.01), and the within-network heterogeneity variance was estimated to be 0.00.…”