Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus and post-operative nausea and vomiting in patients undergoing caesarean section

Koju, Ram Bhakta; Gurung, Bandana Sharma; Dongol, Yashad

doi:10.1186/1471-2253-15-18

Cited by 52 publications

(59 citation statements)

References 30 publications

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“…Recently two papers has been published which analyzed the use of prophylactic ondansetron in parturients, and showed conflicting results. In one study, pruritus was reduced by 72%, while in another study there was no reduction in pruritus, both compared to placebo [21] [25]. In our study, there were no differences in the incidence of pruritus and use of antipruritic medication (promethazine).…”

Section: Discussioncontrasting

confidence: 51%

“…Therefore, we use the NRS as a method of evaluation of pain at rest and on movement in this study [13]. mg prophylactic ondansetron had an incidence of 8% of PONV, whereas those receiving placebo the incidence was 56% [21]. While Imeh et al found an incidence of 9.3% and 37% of PONV when they used dexamethasone plus ondansetron prophylactically compared to dexamethasone in patients who received 0.2 mg of ITM [22].…”

Section: Discussionmentioning

confidence: 97%

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Three Different Doses of Intrathecal Morphine as Part of a Multimodal Regimen for Post-Cesarean Delivery Analgesia: A Randomized Double-Blinded Trial

Benevides¹,

Nochi²,

Solcia³

et al. 2018

OJOG

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Brazil is one of the countries that carry out cesarean delivery in the world. The pain after cesarean delivery (CD) is one of the main concerns of parturient. Intrathecal Morphine (ITM) is widely used for the treatment of pain after CD; however, the optimal dose with minimal side effects is to be established. Objectives: To compare the analgesia and side effects resulted by three different doses of ITM as part of a multimodal regimen for postcesarean delivery analgesia. Methods: One hundred ninety-four patients were sampled in this randomized, double-blinded, three-arm study (group 0.075: ITM 0.75 mg; group 0.1: ITM 0.1 mg and group 0.15: ITM 0.15 mg). All patients received intravenous dexamethasone, dipyrone and ketoprofen. The primary endpoint was pain intensity measured at rest and on movement, while the secondary endpoint was overall satisfaction with pain relief, the incidence of nausea and vomiting, intensity of pruritus, and the use of additional tramadol, antipruritic and antiemetic use within 24 hours after postoperation. Results: The three groups showed similar pain intensity at rest and on movement. The pain intensity on movement was significantly higher than at rest in the groups (p < 0.001). There were no significant differences among the groups regarding secondary endpoint. Conclusions: Our findings suggest that in cases of an elective CD, 0.075 mg of ITM produces postoperative analgesia of similar quality that provided by 0.1 or 0.15 mg ITM. The patients should have a multimodal analgesia approach that includes: ITM, anti-inflammatory agents and access to additional systemic analgesic if necessary.

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 97%

Three Different Doses of Intrathecal Morphine as Part of a Multimodal Regimen for Post-Cesarean Delivery Analgesia: A Randomized Double-Blinded Trial

Benevides¹,

Nochi²,

Solcia³

et al. 2018

OJOG

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“…Obstetric patients received ondansetron before neuraxial morphine administration in only one study . Subgroup analysis showed that pretreatment ondansetron after neuraxial morphine administration was not associated with a decreased rate of pruritus among obstetric patients (RR=0.92, 95% CI 0.81‐1.06, P =.24; Heterogeneity I 2 =61%).…”

Section: Resultsmentioning

confidence: 99%

Ondansetron for neuraxial morphine-induced pruritus: A meta-analysis of randomized controlled trials

Wang

Zhou

2017

J Clin Pharm Ther

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SummaryWhat is known and objective: Pruritus is one of the most common adverse effects associated with neuraxial morphine. Ondansetron has been used to deal with the problem of neuraxial morphine-induced pruritus (NMIP). The aim of this meta-analysis was to evaluate the preventive efficacy of ondansetron on NMIP. Methods: Online databases such as PubMed, EMBASE and the Cochrane CentralRegister of Controlled Trials were searched for eligible randomized controlled trials (RCTs). The primary outcome was the incidence of NMIP. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data. Trial sequential analysis (TSA) was performed to avoid the risk of making a spurious claim of significant effect and to calculate the sample size necessary to make a robust claim of effect. Results and discussion:Our traditional meta-analysis showed that prophylactic ondansetron could significantly reduce the incidence of NMIP in non-obstetric patients (three trials, RR=0.63, 95% CI 0.45-0.89, P=.008) with modest heterogeneity (I 2 =47%)while it did not show the preventive efficacy of NMIP in obstetric patients (seven trials, RR=0.84, 95% CI 0.69-1.03, P=.10) with obvious heterogeneity (I 2 =82% ). However, TSA demonstrates that more high-quality RCTs are still needed to confirm the preventive efficacy of ondansetron on NMIP in non-obstetric populations and to study whether ondansetron prevents NMIP in obstetric patients.What is new and conclusion: Prophylactic ondansetron can significantly reduce the incidence of NMIP in non-obstetric patients but not in obstetric patients. However, more well-designed trials are still required to test the reliability of the results in our traditional meta-analysis. K E Y W O R D Sclinical pharmacy, meta-analysis, morphine, ondansetron, pruritus to be applied in meta-analyses to assess the reliability of the evidence in traditional meta-analysis and provide the sample size necessary to make a robust claim of effect (termed as the required information size, RIS). 10,11 Therefore, we performed this study to evaluate the preventive efficacy of ondansetron on neuraxial morphine-induced pruritus. | WHAT IS KNOWN AND OBJECTIVE | METHODS This meta-analysis was conducted according to the PreferredReporting Items for Systematic Reviews and Meta-analyses (PRISMA)guidelines. 12 | Search strategyThree databases such as PubMed, EMBASE and the Cochrane CentralRegister of Controlled Trials were searched with language restriction to English for randomized controlled trials (RCTs) assessing the preventive effectiveness of ondansetron on NMIP. Besides, we also manually screened the reference lists of relevant reviews and studies for eligible articles. The search strategies for the three online databases were given in Appendix S1. The last search was conducted on 10 March 2017. | Eligibility criteria and study selectionFull-text RCTs published in English that compared the preventive efficacy of intravenous ondansetron versus control (namely, 0.9% normal saline) on pruritus induced by neuraxia...

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“…Ondansetron also demonstrated effectiveness reducing postoperative nausea and vomiting, two side effects that were seen more frequently in the placebo group (8% and 56%, respectively) [11]. In another study investigating intrathecal morphine-induced itching, Kung et al prophylactically used 8 mg IV ondansetron during umbilical cord clamping or postoperatively in the postanesthesia recovery room as a therapeutic dose in 82 patients who had undergone cesarean section, while the placebo group received only physiologic saline.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Mirtazapine,Gabapentin and Ondansetron to prevent intrathecal morphine induced pruritus

Akhan

Subaşı

Bosna

et al. 2016

North Clin Istanbul

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OBJECTIVE:Antagonism of the central nervous system inhibitor neurotransmitter gamma-Aminobutyric acid (GABA) or serotonergic system activation is an important factor in the pathogenesis of intrathecal morphine-induced pruritus. This study tested the hypothesis that preoperative use of ondansetron, gabapentin or mirtazapine can prevent morphine-induced pruritus.METHODS:We randomly allocated 80 patients of American Society of Anesthesiology (ASA) classification I and II physical status who were to undergo unilateral inguinal hernia or pilonidal sinus operations under spinal anesthesia into 4 equal groups. The first 3 groups received oral doses of 30 mg mirtazapine, 8 mg ondansetron, and 1200 mg gabapentin at 2 hours, 10 minutes, and 1 hour before surgery, respectively, and the fourth group was given a placebo. All patients received intrathecal injection of 15 mg of 0.5% hyperbaric bupivacaine and 0.2 mg morphine. Pruritus was evaluated at 0, 3, 6, 9, 12, and 24 hours after intrathecal morphine administration, and details of presence, onset time, duration, localization, and severity of pruritus were recorded.RESULTS:Incidence of pruritus was significantly more frequent in the placebo group compared to ondansetron, gabapentin, and mirtazapine groups (70%, 55%, 35%, and 35%, respectively). In general, onset of pruritus was between 2 and 6 hours after intrathecal morphine injection; however, onset in the gabapentin group (mean±SD: 4.75±2.7 hours; p=0.019) was delayed compared to other groups. It was observed that pruritus persisted relatively longer in the ondansetron and placebo groups (mean±SD: 6±3.08; 5.82±2.96 hours, respectively; p=0.047). No statistical determination was made regarding location of pruritus. Severity of pruritus was greater in the placebo group (p=0.0001). Necessity for antipruritic treatment was not statistically significantly different between groups.CONCLUSION:Incidence and severity of intrathecal morphine-induced pruritus decreased with use of each of all 3 drugs compared to placebo.

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Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus and post-operative nausea and vomiting in patients undergoing caesarean section

Cited by 52 publications

References 30 publications

Three Different Doses of Intrathecal Morphine as Part of a Multimodal Regimen for Post-Cesarean Delivery Analgesia: A Randomized Double-Blinded Trial

Three Different Doses of Intrathecal Morphine as Part of a Multimodal Regimen for Post-Cesarean Delivery Analgesia: A Randomized Double-Blinded Trial

Ondansetron for neuraxial morphine-induced pruritus: A meta-analysis of randomized controlled trials

Comparison of Mirtazapine,Gabapentin and Ondansetron to prevent intrathecal morphine induced pruritus

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