Prevention versus treatment of intrathecal morphine-induced pruritus with ondansetron

Background: Intrathecal morphine is used for post-cesarean analgesia, but pruritus is a common side effect. Ondansetron would be an attractive treatment because it prevents nausea, is non-sedative or has no anti-analgesic effect. We undertook a study to assess the efficacy of ondansetron for treatment or prophylaxis of intrathecal morphine-induced pruritus. Methods: Healthy paturients undergoing cesarean delivery with intrathecal morphine 250 mu g and fentanyl 25 mu g were randomized to receive: prophylaxis (ondansetron 8 mg at cord clamping, normal saline 4 mL for treatment of pruritus in the post-anaesthesia care unit); treatment (normal saline 4 mL at cord clamping, ondansetron 8 mg as required in the post-anesthesia care unit) or control (normal saline 4 mL in both). Visual analogue scale scores for pruritus, nausea and pain were recorded preoperatively, on arrival to, at 30, 60, and 120 mm and on discharge from the post-anesthesia care unit. The primary outcome was the peak pruritus score. ANOVA with Bonferroni correction or Fisher's exact test were used to analyze data; P < 0.05 was considered significant. Results: The study was terminated early when interim analysis indicated no effect. Eighty-two of the intended 180 paturients completed the protocol (26 in control group, 32 in treatment group and 24 in prophylaxis). There were no differences in the rate or severity of pruritus at any assessment point, or the request for treatment. Pruritus was reduced after administration of treatment syringe. Conclusion: Prophylactic ondansetron did not reduce pruritus when compared with placebo. The use of ondansetron as a treatment did not decrease the severity of pruritus when compared with placebo. (C) 2014 Elsevier Ltd. All rights reserved.