Prophylactic ondansetron does not reduce the incidence of itching induced by intrathecal sufentanil.
OBJECTIVE
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 microg). 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.
Waxler
Beverly
B
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. 74731.463@compuserve.com
Mondragon
Shirley A
SA
Patel
Sonal N
SN
Nedumgottil
Kochuthresia
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods; D000982:Antipruritics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007278:Injections, Spinal / Q000379:methods; D008297:Male; D008875:Middle Aged; D017294:Ondansetron / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000139:chemically induced / Q000188:drug therapy; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced* / Q000188:drug therapy*; D012720:Severity of Illness Index; D012965:Sodium Chloride / Q000008:administration & dosage; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000982:Antipruritics; D012965:Sodium Chloride; D017294:Ondansetron; D017409:Sufentanil