Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.11.005
Brazilian Journal of Anesthesiology
Scientific Article

Comparison of droperidol and ondansetron prophylactic effect on subarachnoid morphine-induced pruritus

Comparação dos efeitos profiláticos do droperidol e do ondansetron sobre o prurido provocado pela morfina subaracnoidea

Fabio Ferreira da Cunha Brião; Marcio Leal Horta; Bernardo Lessa Horta; Guilherme Antônio Moreira de Barros; Ana Paula Behrensdorf; Ingrid Severo; Mariana Antunes Nunes; Roberta Boabaid; André Real

Downloads: 0
Views: 106

Abstract

BACKGROUND AND OBJECTIVES:: The prophylactic effect of ondansetron on subarachnoid morphine-induced pruritus is controversial, while evidence suggests that droperidol prevents pruritus. The aim of this study is to compare the effects of droperidol and ondansetron on subarachnoid morphine-induced pruritus.

METHODS:: 180 ASA I or II patients scheduled to undergo cesarean sections under subarachnoid anesthesia combined with morphine 0.2 mg were randomized to receive, after the child's birth, metoclopramide 10 mg (Group I - control), droperidol 2.5 mg (Group II) or ondansetron 8 mg (Group III). Postoperatively, the patients were assessed for pruritus (absent, mild, moderate or severe) or other side effects by blinded investigators. Patients were also blinded to their group allocation. The tendency to present more severe forms of pruritus was compared between groups. NNT was also determined.

RESULTS:: Patients assigned to receive droperidol [Proportional odds ratio: 0.45 (95% confidence interval 0.23-0.88)] reported less pruritus than those who received metoclopramide. Ondansetron effect was similar to metoclopramide [Proportional odds ratio: 0.95 (95% confidence interval 0.49-1.83)]. The NNT for droperidol and ondansetron was 4.0 and 14.7, respectively.

CONCLUSIONS:: Ondansetron does not inhibit subarachnoid morphine-induced pruritus.

Keywords

Droperidol, Morphine, Ondansetron, Pruritus, Subarachnoid injection

Resumo

JUSTIFICATIVA E OBJETIVOS:: O efeito profilático do ondansetron sobre prurido provocado pela morfina subaracnoidea é controverso, enquanto evidências sugerem que o droperidol previne o prurido. O objetivo do presente trabalho é comparar o efeito do droperidol com o do ondansetron sobre o prurido provocado pela morfina subaracnoidea.

MÉTODOS:: 180 pacientes ASA I ou II programadas para serem submetidas a cesarianas sob anestesia subaracnoidea à qual foram acrescentados 0,2 mg de morfina foram divididas aleatoriamente para receber, logo após o nascimento da criança, 10 mg de metoclopramida (grupo I - controle), 2,5 mg de droperidol (grupo II),ou 8 mg de ondansetron (grupo III). No período pós-operatório as pacientes foram avaliadas quanto ao prurido (ausente, leve, moderado ou intenso) ou outros efeitos colaterais por observadores que não sabiam a alocação das pacientes. As pacientes também não sabiam da sua alocação. Os grupos foram comparados pela sua tendência a apresentar formas mais severas de prurido. Também determinamos o NNT.

RESULTADOS:: As pacientes alocadas para receber droperidol [Odds RatioProporcional: 0,45 (Intervalo de Confiança de 95% 0,23 - 0,88)] relataram menos prurido do que as que receberam metoclopramida. O efeito do ondansetron foi semelhante ao da metoclopramida [Odds Ratio Proporcional: 0,95 (Intervalo de Confiança de 95% 0,49 - 1,83)]. O NNT do droperidol foi 4,0 e o do ondansetron foi 14,7.

CONCLUSÕES:: O ondansetron não inibiu o prurido provocado pela morfina subaracnoidea.

Palavras-chave

Droperidol, Morfina, Ondansetron, Prurido, Injeção subaracnoidea

References

Horta ML, Morej6n LCL, da Cruz AW. Study of the prophylactic effect of droperidol, alizapride, propofol and pro- methazine on spinal morphine-induced pruritus. Br J Anaesth.. 2006;96:796-800.

Harrison DM, Sinatra R, Morgese L. Epidural narcotis and patient-controlled analgesia for post-cesarean section pain relief. Anesthesiology.. 1988;68:454-7.

Kjelberg F, Tramér MR. Pharmacological control of opioid-induced pruritus: a quantitative systematic review of randomized trials. Eur J Anesthesiol.. 2001;18:246-57.

Charuluxananan S, Somboonviboon W, Kyokong O. Ondan- setron for treatment of intrathecal morphine-inducedpruritus after cesarean delivery. Reg Anesth Pain Med.. 2000;25:535-9.

Yeh HM, Chen LK, Lin CJ. Prophylactic intravenous ondan- setron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. Anesth Analg.. 2000;91:172-5.

Iatrou CA, Dragoumanis CK, Vogiatzakis GI. Prophy- lactic intravenous ondansetron and dolasetron in intrathecal morphine-induced pruritus: a randomized, double-blinded, placebo-controlled study. Anesth Analg.. 2005;101:1516-20.

Kolm A, Ferraz AAF, Modolo NSP. Profilaxia do prurido cau- sado pela administra,cão subaracn6idea de sufentanil: efeitos do droperidol, da nalbufina, do ondansetron e da combina,cão deles. Rev Bras Anestesiol.. 2006;56:28-33.

Siddik-Sayyid SM, Aquad MT, Taha SK. Does ondansetron or granisetron prevent subarachnoid morphine-induced pruritus after cesarean delivery?. Anest Analg.. 2007;104:421-4.

Tamdee D, Charuluxananan S, Punjasawadwong Y. A ran- domized controlled trial of pentazocine versus ondansetron for the treatment of intrathecal morphine-induced pruri- tus in patients undergoing cesarean delivery. Anesth Analg.. 2009;109:1606-11.

Sarvela PJ, Halonen PM, Soikkeli AI. Ondansetron and topisetron do not prevent intraspinal morphine- and fentanyl-induced pruritus in elective cesarean delivery. Acta Anaesthesiol Scand.. 2006;50:239-44.

Hatfalvi B. Postulated mechanisms for postdural puncture headache and review of laboratory models. Reg Anesth.. 1996;20:329-36.

Ballantyne J. The Massachusets General Hospital handbook of pain management. 2002:117.

Habib AS, Gan TJ. Food and drug administration black box war- ning on the perioperative use of droperidol: a review of the cases. Anesth Analg.. 2003;96:1377-9.

5dd295840e88256230c63493 rba Articles
Links & Downloads

Rev. Bras. Anestesiol.

Share this page
Page Sections