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Prophylactic ondansetron does not reduce the incidence of itching induced by intrathecal sufentanil

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

From the Department of Anesthesiology and Pain Management, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA.

Address correspondence to: Dr. Beverly Waxler, Division of Postanesthesia Care, Department of Anesthesiology and Pain Management, John H. Stroger Jr. Hospital of Cook County, 1901 West Harrison Street, Chicago, IL 60612, USA. Phone: 312-864-2140; Fax: 312-864-9544; E-mail: 74731.463{at}compuserve.com

Purpose: 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.

Methods: 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.

Results: 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).

Conclusions: There are contradictory findings in the literature regarding the effectiveness of ondansetron in preventing narcotic-induced 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.

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