The comparative study of intravenous Ondansetron and sub-hypnotic Propofol dose in control and treatment of intrathecal Sufentanil-induced pruritus in elective caesarean surgery

Objective: Pruritus is a common and disturbing side effect of neuraxial opioids after cesarean section. The purpose of this study was to compare the efficacy of intravenous ondansetron and sub-hypnotic dose of propofol in control and treatment of intrathecal sufentanil induced pruritus in cesarean surgery. Methods: Totally, 90 parturient with American Society of Anesthesiology physical status grade I-II, undergoing spinal anesthesia with 2.5 μg sufentanil and 10 mg bupivacaine 0.5% were enrolled to this randomized, prospective, double-blind study. The women were randomly assigned to two groups who received 8 mg ondansetron or 10 mg propofol to treat pruritus grade ≥3. The patient was evaluated after 5 min and in the lack of successful treatment, the doses of two drugs repeated and if the pruritus is on-going, the exact treatment with naloxone was done. Findings: The incidence of pruritus was 69.3%. Both groups were well-matched. The peak time pruritus was 30-75 min after injection. The percentage of individuals consumed naloxone were 6.8% and 15.9% in ondansetron and propofol groups, respectively (P = 0.18). The mean score of satisfaction (according to visual analog scale criteria) was 9.09 ± 1.1 in ondansetron group and 9.3 ± 1.07 in the propofol group (P = 0.39). Conclusion: Ondansetrone and sub-hypnotic dose of propofol are both safe and well-tolerated. Due to their same efficacy in the treatment of intrathecal sufentanil-induced pruritus, they can be widely used in clinical practice.

[1]  Kamal Kumar,et al.  Neuraxial opioid-induced pruritus: An update , 2013, Journal of anaesthesiology, clinical pharmacology.

[2]  A. Habib,et al.  Serotonin Receptor Antagonists for the Prevention and Treatment of Pruritus, Nausea, and Vomiting in Women Undergoing Cesarean Delivery with Intrathecal Morphine: A Systematic Review and Meta-Analysis , 2009, Anesthesia and analgesia.

[3]  M. Steinhoff,et al.  Neurophysiology of pruritus: interaction of itch and pain. , 2003, Archives of dermatology.

[4]  D. Harmon,et al.  Neuraxial opioid-induced pruritus: a review. , 2003, Journal of clinical anesthesia.

[5]  H. Singh.  Intrathecal fentanyl with small-dose dilute bupivacaine: better anesthesia without prolonging recovery. , 1998, Anesthesia and analgesia.

[6]  Y. Beilin,et al.  Subhypnotic Doses of Propofol Do not Relieve Pruritus Induced by Intrathecal Morphine After Cesarean Section , 1998, Anesthesia and analgesia.

[7]  J. Jakobsson,et al.  Intrathecal Sufentanil, Fentanyl, or Placebo Added to Bupivacaine for Cesarean Section , 1997, Anesthesia and analgesia.

[8]  Spencer S. Liu.  Optimizing Spinal Anesthesia for Ambulatory Surgery , 1996, Regional Anesthesia & Pain Medicine.

[9]  J. Neal,et al.  Fentanyl Prolongs Lidocaine Spinal Anesthesia Without Prolonging Recovery , 1995, Anesthesia and analgesia.

[10]  P. Suter,et al.  The Nonhypnotic Therapeutic Applications of Propofol , 1994, Anesthesiology.

[11]  Y. El‐Sayed,et al.  Intrathecal sufentanil for labor analgesia--sensory changes, side effects, and fetal heart rate changes. , 1993, Anesthesia and analgesia.

[12]  A. Borgeat,et al.  Subhypnotic doses of propofol relieve pruritus induced by epidural and intrathecal morphine. , 1993, Anesthesiology.

[13]  M. Norris.  Height, Weight, and the Spread of Subarachnoid Hyperbaric Bupivacaine in the Term Parturient , 1988, Anesthesia and analgesia.

[14]  J. Kitts,et al.  Naloxone infusion after prophylactic epidural morphine: effects on incidence of postoperative side-effects and quality of analgesia , 1988, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[15]  P. Bromage,et al.  Nonrespiratory Side Effects of Epidural Morphine , 1982, Anesthesia and analgesia.

[16]  N. Rawal,et al.  Postoperative Pain Relief by Epidural Morphine , 1981, Anesthesia and analgesia.

[17]  J. Dostrovsky,et al.  Functional properties of neurons in cat trigeminal subnucleus caudalis (medullary dorsal horn). I. Responses to oral-facial noxious and nonnoxious stimuli and projections to thalamus and subnucleus oralis. , 1981, Journal of neurophysiology.

[18]  Merger,et al.  [Anesthesia in obstetrics]. , 1954, La semaine des hopitaux : organe fonde par l'Association d'enseignement medical des hopitaux de Paris.

[19]  L. Maxwell,et al.  Pathophysiology and Management of Opioid-Induced Pruritus , 2012, Drugs.

[20]  A. Santos,et al.  Local Anesthetics and Opioids , 2009 .