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

Abstract

P Pu ur rp po os se e: : 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.M Me et th ho od ds s: : 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 receive iv 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. R Re es su ul lt ts s: : Ondansetron did not reduce the incidence of pruritus (77 vs 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).C Co on nc cl lu us si io on ns s: : There are contradictory findings in the literature regarding the effectiveness of ondansetron in preventing narcoticinduced 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. Objectif : Le prurit postopératoire induit par l'administration intrathé-cale (IT) de narcotiques est un problème important pour l'anesthésio-logiste 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 : Trente-quatre 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 (10 µg). Les patients, 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

Effects of spinal anaesthesia versus epidural anaesthesia for caesarean section on postoperative analgesic consumption and postoperative pain

“…The incidence of pruritus after epidural or intrathecal opiates is a side-effect that occurs with a frequency ranging between 20 and 80% and little preventive treatment is available [32]. The observed rate of pruritus in our patients was within the reported range [33].…”

Prophylactic Ondansetron for the Prevention of Intrathecal Fentanyl- or Sufentanil-Mediated Pruritus

“…Administration of ondansetron was performed before neuraxial anesthesia in 4 studies [22][23][24][25] and intraoperatively after neuraxial anesthesia in 2 studies. [26][27][28][29] Placebo or control treatment was the administration of IV normal saline in 5 studies, and no intervention in 1 study.…”

“…29 Intrathecal opioids were administered as part of combined spinal-epidural anesthesia in the 2 studies involving obstetric patients 22,26,27 and as part of spinal injection in 4 studies. [23][24][25]28,29 All patients were blinded to the study intervention. Pruritus was assessed by a blinded investigator in 5 of the 6 studies.…”

“…29 Assessment intervals ranged from every 5 to 10 minutes to hourly to daily. Pruritus was subjectively ranked by patients on a 0 to 3 scale (0 absent symptoms, 1 mild, 2 moderate, 3 severe) in 2 studies, 25,26 on a 0 to 4 scale (0 absent, 1 mild, 2 moderate, 3 severe, 4 refractory to rescue treatment) in 1 study, 29 on a 0 to 10 scale (0 absent symptoms, 10 worst possible) in 2 studies, 23,24,27 and on a 0 to 100 scale (0 absent symptoms, 100 worst possible) in 1 study. 22 One study assessed patients for signs of scratching.…”

Ondansetron Treatment in a Child Presenting with Chronic Intractable Pruritus

“…Some studies showed that neuraxial opioid-induced pruritus respond to prophylaxis (3,16,17) and treatment (5,18) with ondansetron. Other studies, however, concluded that ondansetron was not effective in this context (19)(20)(21). Ondansetron seems to be more effective in preventing pruritus induced by morphine than other more potent opioids such as fentanyl and sufentanil.…”