Prophylactic Intravenous Ondansetron and Nalbuphine
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- Category: Vol. 77, September 2009
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Prophylactic Intravenous Ondansetron and Nalbuphine for Reduction of Subarachnoid Fentanyl- Induced Pruritus in Patients Undergoing Elective Cesarean Delivery,MANAL ABDALLA M. ZAGLOL
Abstract
Background: Addition of fentanyl to spinal anaesthesia with bupivacaine improves the quality and success of anaes-thesia. However, it has a frequent incidence of pruritus and a substantial incidence of nausea and vomiting. In this placebo controlled study, we compared the prophylactic efficacy of ondansetron and nalbuphine for the prevention of intrathecal fentanyl-induced pruritus after cesarean delivery.
Methods: Ninety elective parturients were assigned to one of the groups: Group O [Ondansetron 8mg IV n=30], Group N [Nalbuphine 4mg IV n=30] and Group S [Saline 0.9% IV n=30] as placebo. The study drugs were administered immediately after the umbilical cord was clamped. The oc-currence of pruritus, nausea, pain and adverse reactions from ondansetron and nalbuphine was evaluated by pruritus score, 4 - point rating score and visual analog scale respectively, at 15 minutes in the first hour after the injection of the study drugs. Afterward, evaluations were performed at 1, 2, 3 and 4 hours after the administration of study drugs.
Results: The overall incidence of pruritus, it was signifi-cantly more frequent in Group S (62%) compared with both Group O (43%) and Group N (42.5%). The incidence of pruritus during the different study intervals showed significant increase in Group S compared with the other groups mainly at 45min and 1 hour. The pruritus score was significantly different between Group O and Group S and between Group N and Group S (p<0.05) respectively, it was mostly mild in Group O and Group N and mostly moderate in Group S. Treatment for pruritus was requested by patients in, 10%, 11% and 29% of patients in the Group O, Group N and Group S, respectively. There was no significant difference in the overall incidence and the severity of nausea and/or vomiting at different time study intervals for all groups. However, the number of patients requesting treatment for nausea and/or vomiting was significantly less in Group O and Group N when compared with Group S. No significant adverse reactions related to the study drugs reported during the different study intervals.
Coclusion: Although IV ondansetron and nalbuphine significantly decreased the incidence of of fentanyl-induced pruritus more than placebo after cesarean delivery, further studies are recommended to show the other possible mecha-
nisms, might be involved in the pathogenesis of fentanyl-induced pruritus.