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

Prin, Meghan; Guglielminotti, Jean; Moitra, Vivek K.; Li, Guohua

doi:10.1213/ane.0000000000001046

Cited by 15 publications

(16 citation statements)

References 43 publications

(61 reference statements)

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“…However, results from published studies are inconsistent. Neither the meta‐analysis by Bonnet nor by Prin demonstrated an effect of prophylactic 5‐HT3 receptor antagonists on neuraxial opioid‐induced pruritus . As the former study is a pooled analysis of different opioids and different 5‐HT3 receptor antagonists and the latter evaluate the preventive efficacy of ondansetron on intrathecal fentanyl‐ or sufentanil‐mediated pruritus, we performed this meta‐analysis to assess the preventive efficacy of intravenous ondansetron on neuraxial morphine‐induced pruritus.…”

Section: Discussionmentioning

confidence: 99%

“…In our meta‐analysis, intravenous ondansetron before neuraxial morphine administration reduced the rate of pruritus in three non‐obstetric trials and one obstetric trial while administration after neuraxial morphine injection did not demonstrate the preventive efficacy. The meta‐analysis by Prin found intravenous ondansetron before intrathecal morphine reduced rescue medication use for pruritus. As intravenous ondansetron can led to transplacental exposure of the drug to the unborn child, guidelines sometimes require that ondansetron administration be delayed until after umbilical cord clamping .…”

Section: Discussionmentioning

confidence: 99%

“…The meta‐analysis by Prin found intravenous ondansetron before intrathecal morphine reduced rescue medication use for pruritus. As intravenous ondansetron can led to transplacental exposure of the drug to the unborn child, guidelines sometimes require that ondansetron administration be delayed until after umbilical cord clamping . It is worth noting that ondansetron is not recommended for routine use in breastfeeding parturients for it may be excreted in breast milk .…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Wang

Zhou

2017

J Clin Pharm Ther

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“…The administration of prophylactic 8 mg iv ondansetron did not decrease the incidence of pruritus but could decrease the need for rescue medication, especially in specific subgroups including non-obstetric surgery care and in patients who received the drug before the administration of spinal opioids [38]. One of the assumptions is that morphine mechanisms to be less fat-soluble and has a slower onset of analgesia, gives rise to a greater concentration of residual opioid in the cerebrospinal fluid and has a greater cephalic migration.…”

Section: Ht3 Antagonistmentioning

confidence: 91%

An Update on Neuraxial Opioid Induced Pruritus Prevention

2016

JACCOA

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“…La administración i.v. de 8 mg ondansetrón profiláctico no disminuyó la incidencia de prurito, pero puede disminuir la necesidad de medicación de rescate, especialmente en subgrupos específicos incluyendo cirugía no-obstétrica y en los pacientes que recibieron el fármaco antes de la administración de los opioides espinales (38). Uno de los mecanismos postulados es que la morfina, al ser menos liposoluble y más lenta en el inicio de la analgesia, da lugar a una mayor concentración de opioide residual en el líquido cefalorraquídeo y una mayor migración cefálica.…”

Section: Antagonistas 5ht-3unclassified

Actualización en el manejo del prurito inducido por opioides neuraxiales

Bujedo¹

2016

Rev. Soc. Esp. Dolor.

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Instrucciones de citación para el artículo:Mugabure Bujedo Borja. Actualización en el manejo del prurito inducido por opioides neuraxiales. Rev. Soc. Esp. Dolor. 2016. doi: 10.20986/resed.2016.3541/2016 Este es un archivo PDF de un manuscrito inédito que ha sido aceptado para su publicación en la Revista de la Sociedad Española del Dolor. Como un servicio a nuestros clientes estamos proporcionando esta primera versión del manuscrito en estado de prepublicación. El manuscrito será sometido a la corrección de estilo final, composición y revisión de la prueba resultante antes de que se publique en su forma final. Tenga en cuenta que durante el proceso de producción se pueden dar errores lo que podría afectar el contenido final. El copyright y todos los derechos legales que se aplican al artículo pertenecen a la Revista de la Sociedad Española de Dolor. ACTUALIZACIÓN EN EL MANEJO DEL PRURITO INDUCIDO POR OPIOIDES NEURAXIALES AN UPDATE IN THE MANAGEMENT OF NEURAXIAL OPIOID INDUCED PRURITUS B. Mugabure Bujedo Servicio de Anestesiología Reanimación y Tratamiento del dolor. Hospital Universitario Donostia, San Sebastián CORRESPONDENCIA:Borja Mugabure Bujedo mugabure@yahoo.es Recibido 12-11-2016 Aceptado 15-12-2016 ABSTRACTThe itching or pruritus is a secondary effect very annoying that appears after the neuroaxial administration (epidural or intrathecal) of opioid drugs. Sometimes it can even be more unpleasant that the own pain by itself. Either prevention or treatment remains a challenge in the clinical practice of care for these patients. A wide variety of medications with different mechanisms of action have been used and focused in its management, with widely varying results. The objective of this article is to review the literature and summarize the current evidence of the mechanisms and pharmacological treatments available to handle pruritus induced by spinal opioids. The source of articles of this review was obtained through PubMed, Medline and Scopus until December 2016. These search results have been limited to the randomized controlled trials, systematized or comprehensive reviews and from opinion articles of experts in the subject. The most useful drugs are opioid mu antagonists, as naloxone, and mixed opioids kappa agonists /mu antagonists, as nalbuphine and butorphanol, the latter being able in addition to maintaining the analgesia. They have also shown some effectiveness, but to a lesser degree, from receptor antagonists of the serotonin 5-HT3, as ondasetron, administered prophylactically, and the antagonists of dopaminergic receptors D2, as dehidrobenzoperidol. Finally subanesthetic low dose of propofol and prophylactic oral mitarzapine and gabapentin have been used with medium results.Key words: Neuraxial opioids, itching, pruritus, postoperative complications, epidural, intradural, mu and kappa opioid receptors. RESUMENEl picor o prurito es un efecto secundario muy molesto que aparece tras la administración neuroaxial (epidural e intratecal) de fármacos opioides. A veces puede ser incluso más desagr...

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

Abstract: IV 8 mg prophylactic ondansetron does not decrease the incidence of fentanyl- or sufentanil-mediated pruritus but may decrease the need for pruritus rescue medication, particularly in specific subgroups. Randomized trials are needed to confirm these results.

Cited by 15 publications

References 43 publications

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

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

An Update on Neuraxial Opioid Induced Pruritus Prevention

Actualización en el manejo del prurito inducido por opioides neuraxiales

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