Reduction of severity of pruritus after elective caesarean section under spinal anaesthesia with subarachnoid morphine: a randomised comparison of prophylactic granisetron and ondansetron.
AffiliationDepartment of Anaesthesia and Perioperative Medicine, Coombe Women and Infants, University Hospital, Dublin, Ireland. email@example.com
Analgesics, Opioid/*adverse effects
Anesthesia, Spinal/*adverse effects
Granisetron/administration & dosage/*therapeutic use
Ondansetron/administration & dosage/*therapeutic use
Postoperative Complications/*chemically induced/*prevention & control
Postoperative Nausea and Vomiting/prevention & control
Pruritus/*chemically induced/*prevention & control
Serotonin Antagonists/administration & dosage/*therapeutic use
Surgical Procedures, Elective
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CitationInt J Obstet Anesth. 2010 Jan;19(1):56-60. Epub 2009 Nov 27.
JournalInternational journal of obstetric anesthesia
AbstractBACKGROUND: The incidence of pruritus after elective caesarean section under spinal anaesthesia with subarachnoid morphine may be 60-100%, and is a common cause of maternal dissatisfaction. Ondansetron has been shown to reduce pruritus but the effect is short-lived. The objective of this randomized double-blind trial was to evaluate the anti-pruritic efficacy of granisetron compared with ondansetron. METHODS: Eighty ASA I or II women undergoing elective caesarean section received spinal anaesthesia with 0.5% hyperbaric bupivacaine 10 mg, fentanyl 25 microg and preservative-free morphine 150 microg. After delivery of the baby and clamping of the umbilical cord, they were randomised to receive granisetron 3mg i.v. (group G) or ondansetron 8 mg i.v. (group O). RESULTS: The two groups were similar for age, gestational age, height and weight. According to visual analogue pruritus scores, patients in group G experienced less pruritus at 8h (P=0.003) and 24h (P=0.01). Fewer patients in group G (n=8) than group O (n=18) required rescue anti-pruritic medication (P=0.03). Satisfaction scores were also higher in group G than in group O (P=0.03). There was no difference in overall incidence of pruritus, nausea and vomiting, and visual analogue pain scores between the two groups. CONCLUSIONS: Administration of granisetron 3mg i.v. reduces the severity of pruritus and the use of rescue anti-pruritic medication, and improves satisfaction but does not reduce the overall incidence of pruritus in women who have received subarachnoid morphine 150 microg compared to ondansetron 8 mg i.v.