Management of opioid-induced pruritus: a role for 5-HT3 antagonists?
We have evaluated the efficacy of ondansetron in the prevention of opioid-induced pruritus in a prospective, randomized, double-blind, placebo-controlled study. Using a 'human model' of opioid-induced pruritus, 80 ASA I-II patients about to undergo routine surgery were given either ondansetron 4 mg i.v. or 0.9% saline i.v. (40 in each group), 30 min before alfentanil 10 mg kg-1 i.v. During the following 5 min, patients were observed for signs of perinasal scratching and at 5 min were asked about symptoms of pruritus. The study was then terminated and anaesthesia was induced. There was a significant reduction in the incidence of scratching in patients receiving ondansetron compared with placebo (42.5% vs 70%, respectively, P = 0.013). The incidence of itching in the ondansetron group was less than that in the placebo group but this was not statistically significant (30% vs 42.5%, respectively, P = 0.245). We conclude that the 5-HT3 antagonist ondansetron may have a role in the management of opioid-induced pruritus.
Kyriakides
K
K
University Department of Anaesthesia, Queen's Medical Centre, Nottingham, UK.
Hussain
S K
SK
Hobbs
G J
GJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D015760:Alfentanil / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000009:adverse effects*; D004311:Double-Blind Method; D003875:Drug Eruptions / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017294:Ondansetron / Q000627:therapeutic use*; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced / Q000517:prevention & control*; D012702:Serotonin Antagonists / Q000627:therapeutic use*
D000701:Analgesics, Opioid; D012702:Serotonin Antagonists; D015760:Alfentanil; D017294:Ondansetron