Borgeat A, Stirnemann H R
Department of Anesthesia, Orthopedic University Clinic of Zurich/Balgrist, Zurich, Switzerland.
Anesthesiology. 1999 Feb;90(2):432-6. doi: 10.1097/00000542-199902000-00017.
Spinally and epidurally administered morphine is frequently associated with pruritus. Isolated case reports indicate that ondansetron may be effective in this context. This study aims to investigate the effectiveness of ondansetron to treat this side effect.
In a prospective, randomized, double-blind, placebo-controlled study, 100 patients with pruritus (> 4 on a visual analog scale, on which 0 represents no pruritus and 10 represents worst pruritus imaginable) after spinal or epidural administration of morphine, received either 8 mg ondansetron intravenously (ondansetron group) in 100 ml NaCl 0.9% or vehicle (placebo group). A decrease of more than 4 points on the visual analog scale 60 min after treatment was considered a success. Changes in levels of pain and sedation, hemodynamic values, and other side effects were checked regularly. The presence or absence of pruritus was assessed for the last time 24 h later.
The two groups were similar for demographic characteristics, the route of administration of morphine, and severity of pruritus at the beginning of the study. The ondansetron group showed a success rate of 70% versus 30% for the placebo group (P > 0.05). Among the successfully treated patients, three (9%) in the ondansetron group and six (40%) in the placebo group reported the recurrence of pruritus (P < 0.05). Among the successfully treated patients, none complained of residual pruritus 24 h later. No changes in pain or sedation levels were noted. Hemodynamic values remained stable, hemoglobin oxygen saturation did not decrease, and no other side effects were observed.
The administration of 8 mg ondansetron intravenously is an effective treatment for spinally or epidurally administered morphine-induced pruritus. In this clinical condition the treatment is safe and well tolerated.
脊髓和硬膜外给予吗啡常伴有瘙痒。个别病例报告表明，昂丹司琼在这种情况下可能有效。本研究旨在调查昂丹司琼治疗这种副作用的有效性。
在一项前瞻性、随机、双盲、安慰剂对照研究中，100例脊髓或硬膜外给予吗啡后出现瘙痒（视觉模拟评分>4分，0分表示无瘙痒，10分表示可想象到的最严重瘙痒）的患者，分别静脉注射8mg昂丹司琼（昂丹司琼组）于100ml 0.9%氯化钠溶液中或注射溶媒（安慰剂组）。治疗60分钟后视觉模拟评分下降超过4分被视为治疗成功。定期检查疼痛和镇静水平、血流动力学值及其他副作用的变化。24小时后最后一次评估是否存在瘙痒。
两组在人口统计学特征、吗啡给药途径和研究开始时的瘙痒严重程度方面相似。昂丹司琼组的成功率为70%，而安慰剂组为30%（P>0.05）。在治疗成功的患者中，昂丹司琼组有3例（9%）和安慰剂组有6例（40%）报告瘙痒复发（P<0.05）。在治疗成功的患者中，24小时后无人抱怨有残留瘙痒。未观察到疼痛或镇静水平的变化。血流动力学值保持稳定，血红蛋白氧饱和度未降低，未观察到其他副作用。
静脉注射8mg昂丹司琼是治疗脊髓或硬膜外给予吗啡引起的瘙痒的有效方法。在这种临床情况下，该治疗方法安全且耐受性良好。
