Prophylactic Intravenous Ondansetron Reduces the Incidence of Intrathecal Morphine-Induced Pruritus in Patients Undergoing Cesarean Delivery

Yeh, Heui-Ming; Chen, Li-Kuei; Lin, Chun-Chih; Chan, Wen S.; Chen, Yen‐Po; Lin, Chou-Shun; Sun, Wei‐Zen; Wang, Shuo-Meng; Tsai, Shen‐Kou

doi:10.1213/00000539-200007000-00032

Cited by 96 publications

(96 citation statements)

References 23 publications

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“…The dose for intrathecal morphine varied from 0.10 mg to 0.25 mg while for epidural was 3 mg. Observation period of pruritus was 24 hours in 8 researches, 28 hours in one study and 4 hours in one study . Two different doses of ondansetron were used in the trial by Charuluxananan .…”

Section: Resultsmentioning

confidence: 90%

“…The risk of bias for selective reporting was regarded as unclear as we could not obtain the protocol of each trial. Two trials reported power calculation based on the incidence of PONV, leading to high risk of other bias and three gave their power calculation without specific references . The summary and strength of evidence for the primary outcome according to GRADE were shown in Table .…”

Section: Resultsmentioning

confidence: 99%

“…Sensitivity analysis was conducted by removing some studies to test the stability of results. Two studies by Koju and Yeh had an important influence on statistical heterogeneity in the obstetric group. The I 2 value decreased from 82% to 0% while RR only reduced from 0.84 (95% CI 0.69‐1.03) to 0.94 (95% CI 0.88‐1.01) after removing these two studies.…”

Section: Resultsmentioning

confidence: 99%

“…A variety of medications have been used for the prevention of NMIP, among which 5‐hydroxytryptamin‐3 (5HT3) receptor antagonists are of particular interest to anaesthesiologists because they are commonly used for preventing and treating PONV in clinical settings and well tolerated by patients . However, there are conflicting results when ondansetron, a selective 5‐HT3 receptor antagonist, has been used prophylactically for preventing NMIP …”

Section: What Is Known and Objectivementioning

confidence: 99%

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Ondansetron for neuraxial morphine-induced pruritus: A meta-analysis of randomized controlled trials

Wang

Zhou

2017

J Clin Pharm Ther

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SummaryWhat is known and objective: Pruritus is one of the most common adverse effects associated with neuraxial morphine. Ondansetron has been used to deal with the problem of neuraxial morphine-induced pruritus (NMIP). The aim of this meta-analysis was to evaluate the preventive efficacy of ondansetron on NMIP. Methods: Online databases such as PubMed, EMBASE and the Cochrane CentralRegister of Controlled Trials were searched for eligible randomized controlled trials (RCTs). The primary outcome was the incidence of NMIP. We calculated risk ratios (RR) with 95% confidence intervals (CI) for dichotomous data. Trial sequential analysis (TSA) was performed to avoid the risk of making a spurious claim of significant effect and to calculate the sample size necessary to make a robust claim of effect. Results and discussion:Our traditional meta-analysis showed that prophylactic ondansetron could significantly reduce the incidence of NMIP in non-obstetric patients (three trials, RR=0.63, 95% CI 0.45-0.89, P=.008) with modest heterogeneity (I 2 =47%)while it did not show the preventive efficacy of NMIP in obstetric patients (seven trials, RR=0.84, 95% CI 0.69-1.03, P=.10) with obvious heterogeneity (I 2 =82% ). However, TSA demonstrates that more high-quality RCTs are still needed to confirm the preventive efficacy of ondansetron on NMIP in non-obstetric populations and to study whether ondansetron prevents NMIP in obstetric patients.What is new and conclusion: Prophylactic ondansetron can significantly reduce the incidence of NMIP in non-obstetric patients but not in obstetric patients. However, more well-designed trials are still required to test the reliability of the results in our traditional meta-analysis. K E Y W O R D Sclinical pharmacy, meta-analysis, morphine, ondansetron, pruritus to be applied in meta-analyses to assess the reliability of the evidence in traditional meta-analysis and provide the sample size necessary to make a robust claim of effect (termed as the required information size, RIS). 10,11 Therefore, we performed this study to evaluate the preventive efficacy of ondansetron on neuraxial morphine-induced pruritus. | WHAT IS KNOWN AND OBJECTIVE | METHODS This meta-analysis was conducted according to the PreferredReporting Items for Systematic Reviews and Meta-analyses (PRISMA)guidelines. 12 | Search strategyThree databases such as PubMed, EMBASE and the Cochrane CentralRegister of Controlled Trials were searched with language restriction to English for randomized controlled trials (RCTs) assessing the preventive effectiveness of ondansetron on NMIP. Besides, we also manually screened the reference lists of relevant reviews and studies for eligible articles. The search strategies for the three online databases were given in Appendix S1. The last search was conducted on 10 March 2017. | Eligibility criteria and study selectionFull-text RCTs published in English that compared the preventive efficacy of intravenous ondansetron versus control (namely, 0.9% normal saline) on pruritus induced by neuraxia...

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Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: What Is Known and Objectivementioning

confidence: 99%

See 2 more Smart Citations

Ondansetron for neuraxial morphine-induced pruritus: A meta-analysis of randomized controlled trials

Wang

Zhou

2017

J Clin Pharm Ther

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“…They also show antiemetic and antipruritic activity. 10 In Australia, ondansetron is licensed for use only as an antiemetic, and in this study, it was used outside its licensed indication. Ondansetron, however, has been commonly used in clinical practice during pregnancy and cesarean deliveries for a number of years with no safety issues identified.…”

mentioning

confidence: 99%