Reduction of severity of pruritus after elective caesarean section under spinal anaesthesia with subarachnoid morphine: a randomised comparison of prophylactic granisetron and ondansetron

Tan, T.; Ojo, Rosemary; Immani, S.; Choroszczak, P. J.; Carey, Michael

doi:10.1016/j.ijoa.2009.05.005

Cited by 17 publications

(9 citation statements)

References 16 publications

(17 reference statements)

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“…After screening the titles and abstracts, 55 articles were excluded as they were obviously irrelevant trials or duplicates. Subsequently, 15 potentially eligible articles were carefully reviewed and five studies were excluded for they did not meet the eligibility criteria: three were studies without control groups, one was lack of full text after contacting the author and one did not give the incidence of pruritus after we contacted the authors for original data . Finally, ten RCTs comparing the preventive efficacy of intravenous ondansetron with control on neuraxial morphine‐induced pruritus were included in this meta‐analysis …”

Section: Resultsmentioning

confidence: 99%

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: 99%

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

Wang

Zhou

2017

J Clin Pharm Ther

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“…In the case of adults, recent reports suggested that 5‐HT 3 receptor antagonists may be effective for prophylaxis for neuroaxial opioid‐induced pruritus . Ondansetron has been proposed for the treatment of spinal or epidural morphine‐induced pruritus in adults, particularly in obstetric patients, but no clinical trial in children has been conducted .…”

Section: Specific Prophylaxis For Opioid‐induced Pruritusmentioning

confidence: 99%

Strategies for preventing side effects of systemic opioid in postoperative pediatric patients

Jitpakdee

Mandee

2014

Pediatric Anesthesia

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“…8,9 Granisetron has been used in some pregnant women to treat itching from regional anesthesia during cesarean delivery and for postoperative nausea and vomiting. 10 Use of the granisetron patch offers an option not heretofore available to those pregnant women with severe signs and symptoms of nausea and hyperemesis. Limited data exist to describe the pharmacokinetics or pharmacodynamics of the granisetron patch in pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Pharmacodynamics of transdermal granisetron in women with nausea and vomiting of pregnancy

Caritis

Zhao

Chen

et al. 2016

American Journal of Obstetrics and Gynecology

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Granisetron significantly improved symptoms of nausea and vomiting as gauged by the PUQE score. After IV infusion the reduction in PUQE score was observed within 1 day. When granisetron was administered as a patch, benefit likewise was seen within 1 day suggesting rapid absorption of the medication transdermally. The beneficial effect of transdermal granisetron on the PUQE score persisted for the entire 7 days during which the patch was in place. In this small cohort, the granisetron patch appeared to be efficacious in reducing the symptoms of nausea and vomiting. The patch provides another option for treating this disorder and may be particularly useful in women who cannot tolerate oral medications.

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Reduction of severity of pruritus after elective caesarean section under spinal anaesthesia with subarachnoid morphine: a randomised comparison of prophylactic granisetron and ondansetron

Cited by 17 publications

References 16 publications

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

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

Strategies for preventing side effects of systemic opioid in postoperative pediatric patients

Pharmacodynamics of transdermal granisetron in women with nausea and vomiting of pregnancy

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