Kung A T, Yang X, Li Y, Vasudevan A, Pratt S, Hess P
Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Int J Obstet Anesth. 2014 Aug;23(3):222-6. doi: 10.1016/j.ijoa.2014.04.007. Epub 2014 May 15.
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.
Healthy paturients undergoing cesarean delivery with intrathecal morphine 250μg and fentanyl 25μg were randomized to receive: prophylaxis (ondansetron 8mg at cord clamping, normal saline 4mL for treatment of pruritus in the post-anaesthesia care unit); treatment (normal saline 4mL at cord clamping, ondansetron 8mg as required in the post-anesthesia care unit) or control (normal saline 4mL in both). Visual analogue scale scores for pruritus, nausea and pain were recorded preoperatively, on arrival to, at 30, 60, and 120min 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.
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.
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.
鞘内注射吗啡用于剖宫产术后镇痛，但瘙痒是常见的副作用。昂丹司琼可能是一种有吸引力的治疗药物，因为它可预防恶心，无镇静作用或无抗镇痛作用。我们进行了一项研究，以评估昂丹司琼治疗或预防鞘内注射吗啡引起的瘙痒的疗效。
接受250μg鞘内注射吗啡和25μg芬太尼剖宫产的健康产妇被随机分为：预防组（脐带钳夹时给予8mg昂丹司琼，术后麻醉护理单元给予4mL生理盐水用于治疗瘙痒）；治疗组（脐带钳夹时给予4mL生理盐水，术后麻醉护理单元按需给予8mg昂丹司琼）或对照组（两者均给予4mL生理盐水）。术前、到达时、30、60和120分钟以及术后麻醉护理单元出院时记录瘙痒、恶心和疼痛的视觉模拟量表评分。主要结局是瘙痒峰值评分。采用Bonferroni校正的方差分析或Fisher精确检验分析数据；P<0.05被认为具有统计学意义。
中期分析显示无效果时，研究提前终止。计划纳入的180名产妇中有82名完成了方案（对照组26名，治疗组32名，预防组24名）。在任何评估点，瘙痒的发生率或严重程度以及治疗需求均无差异。给予治疗注射器后瘙痒减轻。
与安慰剂相比，预防性使用昂丹司琼并未减轻瘙痒。与安慰剂相比，使用昂丹司琼进行治疗并未降低瘙痒的严重程度。
