Nalbuphine versus ondansetron for prevention of intrathecal morphine-induced pruritus after cesarean delivery.
In this prospective, randomized, double-blinded study, we compared the prophylactic efficacy of nalbuphine and ondansetron for the prevention of intrathecal morphine-induced pruritus after cesarean delivery. Two-hundred-forty parturients were randomly allocated into four groups. The N-4 group, O-4 group, O-8 group, and placebo group received IV 4 mg of nalbuphine, 4 mg of ondansetron, 8 mg of ondansetron, and 4 mL of normal saline, respectively, immediately after the baby was delivered. In the postanesthesia care unit, we found that the severity of pruritus score in the four groups was significantly different (P < 0.001). The prophylactic success rate for pruritus of the N-4, O-4, O-8, and placebo groups was 20%, 13%, 12%, and 6%, respectively (P < 0.001). The pruritus score between N-4 and placebo and O-4 and placebo was significantly different (P < 0.001 and P = 0.006, respectively). Treatment for pruritus was requested by patients in 25%, 47%, 51%, and 72% of patients in the N-4, O-4, O-8, and placebo groups, respectively (P < 0.001). There were no differences among groups in nausea/vomiting score, pain score, sedation score, or shivering score at 4, 8, and 24 h after surgery. Nalbuphine and ondansetron are more effective than placebo for the prevention of intrathecal morphine-induced pruritus after cesarean delivery.


CONCLUSIONS
Nalbuphine and ondansetron are more effective than placebo for the prevention of intrathecal morphine-induced pruritus after cesarean delivery.
Charuluxananan
Somrat
S
*Department of Anesthesiology and †Clinical Epidemiology Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Kyokong
Oranuch
O
Somboonviboon
Wanna
W
Narasethakamol
Arunchai
A
Promlok
Pissamai
P
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D002585:Cesarean Section; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D009020:Morphine / Q000009:adverse effects* / Q000627:therapeutic use; D009266:Nalbuphine / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D017294:Ondansetron / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000188:drug therapy; D011183:Postoperative Complications / Q000139:chemically induced* / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy; D011247:Pregnancy; D011537:Pruritus / Q000139:chemically induced* / Q000517:prevention & control*; D012702:Serotonin Antagonists / Q000627:therapeutic use*
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D012702:Serotonin Antagonists; D017294:Ondansetron; D009020:Morphine; D009266:Nalbuphine