Ondansetron and Metoclopramide Can Prevent Intrathecal Sufentanil-Induced Pruritus

  • Anahita Hirmanpour Anahita Hirmanpour , MD Assistant Professor of Anesthesia Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Tel: 00989133152416 A_HIRMANPOUR@med.mui.ac.ir +98-9133624899
  • Mohammadreza Safavi professor of anesthesia
  • Azim Honarmand Azim Honarmand, MD Professor of Anesthesia Anesthesiology and Critical Care Research Center,Isfahan University of medical sciences, Isfahan, Iran E-mail: honarmand@med.mui.ac.ir Tel: 00989133136286
  • Seyede Hamideh Hashemi Yazdi Seyede Hamideh Hashemi Yazdi,MD Anesthesiology and Critical Care Research Center ,Isfahan University of Medical Sciences, Isfahan, Iran. sitara9636@gmail.com
  • Arash Pourreza Arash Poorreza ,MD Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. arash77p@yahoo.com
Keywords: ondansetron, metoclopramide, spinal anesthesia, pruritus

Abstract

Background: We have compared the effectiveness of metoclopramide and ondansetron in the prevention of pruritus caused by intrathecal injection of sufentanil in parturients undergoing elective caesarean section under spinal anesthesia.

Methods: 123 parturients ASA I & II divided in to 3 groups with random allocation software, with 41 parturient in each group. Spinal anesthesia was performed with 2 ml of bupivacaine 0.5% plus 2.5 microgram sufentanil.

The first group received 4mg of ondansetron, the second group 10mg of metoclopramide and the third group placebo, immediately after clamping of the umbilical cord. During surgery and postoperative period, the parturients were assessed for hemodynamic changes, pruritus, nausea and vomiting and shivering.

Results: There were significant differences in the incidence of pruritus among three groups. The incidence of moderate pruritus was significantly higher in control group (47.5%) in comparison with ondansetron (15.8%) and metoclopramide (10%)groups. Severe pruritus was significantly higher in the control group (15%).The incidence of shivering was significantly lower in metoclopramide group (37.5% in comparison with 89.5% and 72.5% in the ondansetron and control groups). Moreover, the incidence of nausea and vomiting was significantly higher in placebo group.

Conclusion: Ondansetron and metoclopramide can effectively prevent and reduce the severity and the incidence of intrathecal sufentanil induced pruritus. Both drugs can reduce the incidence of nausea and vomiting. Metoclopramide also reduces shivering in this study.

Author Biography

Mohammadreza Safavi, professor of anesthesia

Anesthesiology and Critical Care Research Center ,Isfahan University of Medical Sciences, Isfahan, Iran.

Tel: 00989133152416

safavi@med.mui.ac.ir

References

Cohen SE, Cherry CM, Holbrook RH Jr, el-Sayed YY, Gibson RN, Jaffe RA. Intrathecal sufentanil for labor analgesia--sensory changes, side effects, and fetal heart rate changes. Anesth Analg. 1993; 77(6):1155-60.

Rawal N, Sjostrand U, Dahlstrom B. Postoperative pain relief by epidural morphine. Anesth Analg. 1981; 60(10):726-31.

Norris MC. Height, weight and the spread of subarachnoid hyperbaric bupivacaine in the term parturient. Anesth Analg. 1988; 67(6):555-8.

Bromage PR, Camporesi EM, Durant PA, Nielsen CH. Non respiratory side effects of epidural morphine. Anesth Analg 1982; 61(6):490-5.

I Allen C. Santos, Brenda A. Buklin. Local Anesthetics and Opioids: David H. Chestnut. Obstetric Anesthesia: Mosby Elsevier, 2004: 261

David J, Birnbach& Ingrid M. Anesthesia for obstetrics: Miller RD. Text book of Anesthesia: Chuchil living stone Philadelphia, 2010:2215-19.

Ben-David B, Solomon E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small-dose dilute bupivacaine: better analgesia without prolonging recovery. Anesth AnaIg. 1997; 85(3):560-5.

Liu S, Chiu AA, Carpenter RL, Mulroy MF, Allen HW, Neal JM, et al. Fentanyl prolongs lidocaine spinal anesthesia without prolonging recovery. Anesth Analg. 1995; 80(4):730-4.

Szarvas S, Harmon D, Murphy D. Neuraxial opioid-induced pruritus: a review. J ClinAnesth. 2003; 15(3):234-9.

Allen C. Santos, Brenda A. Buklin. Local Anesthetics and Opioids: David H. Chestnut. Obstetric Anesthesia: Mosby Elsevier,2014: 284

koma A, Rukwied R, Ständer S, Steinhoff M, Miyachi Y, Schmelz M. Neurophysiology of pruritus: Interaction of itch and pain. Arch Dermatol. 2003; 139(11):1475-8.

Hirmanpour A, Safavi M, Honarmand A, Hosseini AZ, Sepehrian M. The comparative study of intravenous Ondansetron and sub-hypnotic Propofol dose in control and treatment of intrathecal Sufentanil-induced pruritus in elective caesarean surgery. J Res Pharm Pract. 2015; 4(2):57-63.

Dominguez JE, Habib AS. Prophylaxis and treatment of the side-effects of neuraxial morphine analgesia following cesarean delivery. Curr Opin Anaesthesiol. 2013; 26(3):288-95.

Kumar K, Singh SI. Neuraxial opioid-induced pruritus: an update. Journal of anaesthesiology, clinical pharmacology. 2013; 29(3):303-7.

Kung AT, Yang X, Li Y, Vasudevan A, Pratt S, Hess P. Prevention versus treatment of intrathecal morphine-induced pruritus with ondansetron. Int J Obstet Anesth. 2014; 23(3):222-6.

Prin M, Guglielminotti J, Moitra V, Li G. Prophylactic ondansetron for the prevention of intrathecal fentanyl-or sufentanil-mediated pruritus: A meta-analysis of randomized trials. Anesth Analg. 2016; 122(2):402-9.

Cottrell BH. A Review of Opioid‐Induced Itching after Cesarean Birth. Nursing for women's health. 2015; 19(2):154-63.

Brião FF, Horta ML, Horta BL, Barros GA, Behrensdorf AP, Severo I, et al. Comparison of droperidol and ondansetron prophylactic effect on subarachnoid morphine-induced pruritus. Rev Bras Anestesiol. 2015; 65(4):244-8.

Published
2018-01-09
How to Cite
1.
Hirmanpour A, Safavi M, Honarmand A, Hashemi Yazdi SH, Pourreza A. Ondansetron and Metoclopramide Can Prevent Intrathecal Sufentanil-Induced Pruritus. Arch Anesth & Crit Care. 4(1):409-16.
Section
Research Article(s)