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OBSTETRIC ANESTHESIA

Nalbuphine Versus Ondansetron for Prevention of Intrathecal Morphine-Induced Pruritus After Cesarean Delivery

Somrat Charuluxananan, MD MSc, FRCAT^*,, Oranuch Kyokong, MD MSc, FRACT^*,, Wanna Somboonviboon, MD FRCAT^*, Arunchai Narasethakamol, MD^*, and Pissamai Promlok, MD^*

*Department of Anesthesiology and Clinical Epidemiology Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Address correspondence and reprint requests to Charuluxananan Somrat, MD, Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Rama IV Rd., Pathumwan, Bangkok 10330, Thailand. Address e-mail to somratcu{at}hotmail.com

In this prospective, randomized, double-blinded study, we compared the prophylactic efficacy of nalbuphine and ondansetron for the prevention of intrathecal morphine-induced pruritus after cesarean delivery. Two-hundred-forty parturients were randomly allocated into four groups. The N-4 group, O-4 group, O-8 group, and placebo group received IV 4 mg of nalbuphine, 4 mg of ondansetron, 8 mg of ondansetron, and 4 mL of normal saline, respectively, immediately after the baby was delivered. In the postanesthesia care unit, we found that the severity of pruritus score in the four groups was significantly different (P < 0.001). The prophylactic success rate for pruritus of the N-4, O-4, O-8, and placebo groups was 20%, 13%, 12%, and 6%, respectively (P < 0.001). The pruritus score between N-4 and placebo and O-4 and placebo was significantly different (P < 0.001 and P = 0.006, respectively). Treatment for pruritus was requested by patients in 25%, 47%, 51%, and 72% of patients in the N-4, O-4, O-8, and placebo groups, respectively (P < 0.001). There were no differences among groups in nausea/vomiting score, pain score, sedation score, or shivering score at 4, 8, and 24 h after surgery. Nalbuphine and ondansetron are more effective than placebo for the prevention of intrathecal morphine-induced pruritus after cesarean delivery.

IMPLICATIONS: Nalbuphine and ondansetron are more effective than placebo for the prevention of intrathecal morphine-induced pruritus after cesarean delivery.

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