Reduction of severity of pruritus after elective caesarean section under spinal anaesthesia with subarachnoid morphine: a randomised comparison of prophylactic granisetron and ondansetron.
BACKGROUND
The incidence of pruritus after elective caesarean section under spinal anaesthesia with subarachnoid morphine may be 60-100%, and is a common cause of maternal dissatisfaction. Ondansetron has been shown to reduce pruritus but the effect is short-lived. The objective of this randomized double-blind trial was to evaluate the anti-pruritic efficacy of granisetron compared with ondansetron.


METHODS
Eighty ASA I or II women undergoing elective caesarean section received spinal anaesthesia with 0.5% hyperbaric bupivacaine 10 mg, fentanyl 25 microg and preservative-free morphine 150 microg. After delivery of the baby and clamping of the umbilical cord, they were randomised to receive granisetron 3mg i.v. (group G) or ondansetron 8 mg i.v. (group O).


RESULTS
The two groups were similar for age, gestational age, height and weight. According to visual analogue pruritus scores, patients in group G experienced less pruritus at 8h (P=0.003) and 24h (P=0.01). Fewer patients in group G (n=8) than group O (n=18) required rescue anti-pruritic medication (P=0.03). Satisfaction scores were also higher in group G than in group O (P=0.03). There was no difference in overall incidence of pruritus, nausea and vomiting, and visual analogue pain scores between the two groups.


CONCLUSIONS
Administration of granisetron 3mg i.v. reduces the severity of pruritus and the use of rescue anti-pruritic medication, and improves satisfaction but does not reduce the overall incidence of pruritus in women who have received subarachnoid morphine 150 microg compared to ondansetron 8 mg i.v.
Tan
T
T
Department of Anaesthesia and Perioperative Medicine, Coombe Women and Infants University Hospital, Dublin, Ireland. tutan@me.com
Ojo
R
R
Immani
S
S
Choroszczak
P
P
Carey
M
M
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D002585:Cesarean Section; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D017829:Granisetron / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007267:Injections; D009020:Morphine / Q000009:adverse effects*; D017294:Ondansetron / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000139:chemically induced* / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011247:Pregnancy; D011537:Pruritus / Q000139:chemically induced* / Q000517:prevention & control*; D012702:Serotonin Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D013346:Subarachnoid Space
D000701:Analgesics, Opioid; D017829:Granisetron; D009020:Morphine; D017294:Ondansetron; D012702:Serotonin Antagonists