Effects of Prophylactic Ondansetron for Preventing Intrathecal Opioid-induced Pruritus: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

DU Yu , LIU Hui ,  LIN Xuemei

Department of Anesthesia, West China Second Hospital of Sichuan University, Chengdu 610041, China;

Corresponding author：

LIN Xuemei, Email: lxm0301@gmail.com

Keywords：

Intravertebral analgesia; Ondansetron; Opioid; Randomized controlled trial; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20120094

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Objective 　To evaluate the effects of prophylactic ondansetron for preventing intrathecal opioid induced pruritus.
Methods 　According to the Cochrane Handbook, such databases as The Cochrane Library, OVID, EMbase, PubMed, CNKI and CBM were searched to collect the randomized controlled trials (RCTs) about ondansetron for preventing intrathecal opioid induced pruritus. According to the predefined inclusion and exclusion criteria, the literatures were screened, and meta-analysis was conducted by using RevMan 5.0 software.
Results 　Eight RCTs involving 577 patients were included. The quality evaluation showed the bias of all studies was unclear. Meta-analysis showed that because the heterogeneity of the included studies was so large (P=0.0001, I2=80%), subgroup analyses were performed. The subgroup analyses on surgery methods showed no statistical heterogeneity among all subgroups. a) There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in arthroscopic knee or urologic surgery (RR=0.49, 95%CI 0.35 to 0.67); b) There was no significant difference in incidence rate of pruritus between the ondansetron group and the control group in obstetric surgery (RR=0.98, 95%CI 0.86 to 1.12); c) There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in gynecologic surgery (RR=0.51, 95%CI 0.34 to 0.76); and d) There was no significant difference in the incidence rate of pruritus between the ondansetron group and the control group in outpatient surgery (RR=0.49, 95%CI 0.35 to 0.67).
Conclusion 　The subgroup analyses performed because of the large heterogeneity of the included studies indicate that ondansetron can prevent the intrathecal opioid induced pruritus in arthroscopic knee, urologic and gynecological surgeries rather than obstetric and outpatient surgeries. Due to the small scale, large heterogeneity and unclear quality evaluation of the included studies, more high quality RCTs are required to provide reliable evidence.

Citation： DU Yu,LIU Hui,LIN Xuemei. Effects of Prophylactic Ondansetron for Preventing Intrathecal Opioid-induced Pruritus: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2012, 12(5): 583-588. doi: 10.7507/1672-2531.20120094 Copy

1.	Charuluxananan S, Kyokong O, Somboonviboon W, et al. Nalbuphine versus propofol for treatment of intrathecal morphine-induced pruritus after cesarean delivery. Anesth Analg, 2001, 93(1): 162-165.
2.	Yeh HM, Chen LK, Lin CJ, et al. Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. Anesth Analg, 2000, 91(1): 172-175.
3.	Charuluxananan S, Kyokong O, Somboonviboon W, et al. Nalbuphine versus ondansetron for prevention of intrathecal morphine-induced pruritus after cesarean delivery. Anesth Analg, 2003, 96(6): 1789-1793.
4.	Kjellberg F, Tramer MR. Pharmacological control of opioid-induced pruritus: a quantitative system atic review of randomized trials. Eur J Anaesthesiol, 2001, 18(6): 346-357.
5.	Hindle AT. Recent developments in the physiology and pharmacology of 5-hydroxytryptamine. Br J Aanesth, 1994, 73(3): 395-407.
6.	Raderer M, Muller C, Scheithauer W. Ondansetron for pruritus due to cholestasis. N Engl J Med, 1994, 330(21): 1540.
7.	Higgins JPT, Green S. Assessing risk of bias in included studies: Cochrane Handbook for Systematic Reviews of Interventions 5.1.0.[updated March 2011], The Cochrane Collaboration, 2011. Available from: URL: http://www.cochrane-handbook.org.
8.	Waxler B, Mondragon SA, Patel SN, et al. Prophylactic ondansetron does not reduce the incidence of itching induced by intrathecal sufentanil. Can J Anesth, 2004, 51(7): 685-689.
9.	Sarvela PJ, Halonen PM, Soikkeli AI, et al. Ondansetron and tropisetron do not prevent intraspinal morphine and fentanyl-induced pruritus in elective cesarean delivery. Acta Anaesthesiol Scand, 2006, 50(2): 239-244.
10.	Wells J, Paech MJ, Evans SF. Intrathecal fentanyl-induced pruritus during labour: the effect of prophylactic ondansetron. Int J Obstet Anesth, 2004, 13(1): 35-39.
11.	Siddik-Sayyid SM, Aouad MT, Taha SK, et al. Does Ondansetron or Granisetron Prevent Subarachnoid Morphine-Induced Pruritus After Cesarean Delivery? Anesth Analg, 2007, 104(2): 421-424.
12.	Tzeng JI, Chu KS, Ho ST, et al. Prophylactic iv ondansetron reduces nausea, vomiting and pruritus following epidural morphine for postoperative pain control. Can J Anesth, 2003, 50(10): 1023-1026.
13.	Iatrou CA, Dragoumanis CK, Vogiatzaki TD, et al. Prophylactic Intravenous Ondansetron and Dolasetron in Intrathecal Morphine-Induced Pruritus: A Randomized, Double-Blinded, Placebo-Controlled Study. Anesth Analg, 2005, 101(5): 1516-1520.
14.	王丽秋, 郭亚忠, 陶玉娟. 昂丹司琼对蛛网膜下腔使用吗啡导致的皮肤瘙痒的预防作用. 中国伤残医学, 2009, 17(4): 11-12.
15.	Yavuz G, Kamil T. Prophylactic Ondansetron Reduces the Incidence of Intrathecal Fentanyl-Induced Pruritus. Anesth Analg, 2002, 95(2): 1763-1766.
16.	Mulroy MF, Larkin KL, Siddiqui A. Intrathecal fentanyl-induced pruritus is more severe in combination with procaine than with lidocaine or bupivacaine. Reg Anesth Pain Med, 2001, 26(3): 252-256.
17.	Shah MK, Sia AT, Chong JL. The effect of the addition of ropivacaine or bupivacaine upon pruritus induced by intrathecal fentanyl in labor. Anaesthesia, 2000, 55(10): 1008-1013.
18.	Yeh HM, Chen LK, Lin CJ, et al. Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. Anesth Analg, 2000, 91(1): 172-175.
19.	Kyriakides K, Hussain SK, Hobbs GJ. Management of opioid-induced pruritus: a role for 5-HT3 antagonists? Br J Anaesth, 1999, 82(3): 439-441.
20.	Ikoma A, Rukwied R, Stander S, et al. Neurophysiology of pruritus: interaction of itch and pain. Arch Dermatol, 2003, 139(11): 1475-1478.

1. Charuluxananan S, Kyokong O, Somboonviboon W, et al. Nalbuphine versus propofol for treatment of intrathecal morphine-induced pruritus after cesarean delivery. Anesth Analg, 2001, 93(1): 162-165.
2. Yeh HM, Chen LK, Lin CJ, et al. Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. Anesth Analg, 2000, 91(1): 172-175.
3. Charuluxananan S, Kyokong O, Somboonviboon W, et al. Nalbuphine versus ondansetron for prevention of intrathecal morphine-induced pruritus after cesarean delivery. Anesth Analg, 2003, 96(6): 1789-1793.
4. Kjellberg F, Tramer MR. Pharmacological control of opioid-induced pruritus: a quantitative system atic review of randomized trials. Eur J Anaesthesiol, 2001, 18(6): 346-357.
5. Hindle AT. Recent developments in the physiology and pharmacology of 5-hydroxytryptamine. Br J Aanesth, 1994, 73(3): 395-407.
6. Raderer M, Muller C, Scheithauer W. Ondansetron for pruritus due to cholestasis. N Engl J Med, 1994, 330(21): 1540.
7. Higgins JPT, Green S. Assessing risk of bias in included studies: Cochrane Handbook for Systematic Reviews of Interventions 5.1.0.[updated March 2011], The Cochrane Collaboration, 2011. Available from: URL: http://www.cochrane-handbook.org.
8. Waxler B, Mondragon SA, Patel SN, et al. Prophylactic ondansetron does not reduce the incidence of itching induced by intrathecal sufentanil. Can J Anesth, 2004, 51(7): 685-689.
9. Sarvela PJ, Halonen PM, Soikkeli AI, et al. Ondansetron and tropisetron do not prevent intraspinal morphine and fentanyl-induced pruritus in elective cesarean delivery. Acta Anaesthesiol Scand, 2006, 50(2): 239-244.
10. Wells J, Paech MJ, Evans SF. Intrathecal fentanyl-induced pruritus during labour: the effect of prophylactic ondansetron. Int J Obstet Anesth, 2004, 13(1): 35-39.
11. Siddik-Sayyid SM, Aouad MT, Taha SK, et al. Does Ondansetron or Granisetron Prevent Subarachnoid Morphine-Induced Pruritus After Cesarean Delivery? Anesth Analg, 2007, 104(2): 421-424.
12. Tzeng JI, Chu KS, Ho ST, et al. Prophylactic iv ondansetron reduces nausea, vomiting and pruritus following epidural morphine for postoperative pain control. Can J Anesth, 2003, 50(10): 1023-1026.
13. Iatrou CA, Dragoumanis CK, Vogiatzaki TD, et al. Prophylactic Intravenous Ondansetron and Dolasetron in Intrathecal Morphine-Induced Pruritus: A Randomized, Double-Blinded, Placebo-Controlled Study. Anesth Analg, 2005, 101(5): 1516-1520.
14. 王丽秋, 郭亚忠, 陶玉娟. 昂丹司琼对蛛网膜下腔使用吗啡导致的皮肤瘙痒的预防作用. 中国伤残医学, 2009, 17(4): 11-12.
15. Yavuz G, Kamil T. Prophylactic Ondansetron Reduces the Incidence of Intrathecal Fentanyl-Induced Pruritus. Anesth Analg, 2002, 95(2): 1763-1766.
16. Mulroy MF, Larkin KL, Siddiqui A. Intrathecal fentanyl-induced pruritus is more severe in combination with procaine than with lidocaine or bupivacaine. Reg Anesth Pain Med, 2001, 26(3): 252-256.
17. Shah MK, Sia AT, Chong JL. The effect of the addition of ropivacaine or bupivacaine upon pruritus induced by intrathecal fentanyl in labor. Anaesthesia, 2000, 55(10): 1008-1013.
18. Yeh HM, Chen LK, Lin CJ, et al. Prophylactic intravenous ondansetron reduces the incidence of intrathecal morphine-induced pruritus in patients undergoing cesarean delivery. Anesth Analg, 2000, 91(1): 172-175.
19. Kyriakides K, Hussain SK, Hobbs GJ. Management of opioid-induced pruritus: a role for 5-HT3 antagonists? Br J Anaesth, 1999, 82(3): 439-441.
20. Ikoma A, Rukwied R, Stander S, et al. Neurophysiology of pruritus: interaction of itch and pain. Arch Dermatol, 2003, 139(11): 1475-1478.

Chinese Journal of Evidence-Based Medicine

Effects of Prophylactic Ondansetron for Preventing Intrathecal Opioid-induced Pruritus: A Systematic Review

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