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Management of opioid-induced pruritus: a role for 5-HT3 antagonists?
K Kyriakides1, S K Hussain, G J Hobbs
1University Department of Anaesthesia, Queen's Medical Centre, Nottingham, UK.
Abstract:
We have evaluated the efficacy of ondansetron in the prevention of opioid-induced pruritus in a prospective, randomized, double-blind, placebo-controlled study. Using a 'human model' of opioid-induced pruritus, 80 ASA I-II patients about to undergo routine surgery were given either ondansetron 4 mg i.v. or 0.9% saline i.v. (40 in each group), 30 min before alfentanil 10 mg kg-1 i.v. During the following 5 min, patients were observed for signs of perinasal scratching and at 5 min were asked about symptoms of pruritus. The study was then terminated and anaesthesia was induced. There was a significant reduction in the incidence of scratching in patients receiving ondansetron compared with placebo (42.5% vs 70%, respectively, P = 0.013). The incidence of itching in the ondansetron group was less than that in the placebo group but this was not statistically significant (30% vs 42.5%, respectively, P = 0.245). We conclude that the 5-HT3 antagonist ondansetron may have a role in the management of opioid-induced pruritus.
Insights
Ondansetron significantly reduced scratching caused by opioids in a study of 80 patients. While itching was less frequent with ondansetron, the difference was not statistically significant, suggesting a potential role for this drug in managing opioid-induced pruritus.
Area of Science:
- Anesthesiology
- Pharmacology
Background:
- Opioid administration can cause pruritus (itching) and scratching.
- Effective management strategies for opioid-induced pruritus are needed.
Purpose of the Study:
- To evaluate the efficacy of ondansetron in preventing opioid-induced pruritus.
Main Methods:
- A prospective, randomized, double-blind, placebo-controlled study was conducted.
- Eighty patients received either ondansetron 4 mg IV or placebo 30 minutes before alfentanil administration.
- Patients were monitored for scratching and pruritus symptoms.
Main Results:
- A significant reduction in scratching incidence was observed in the ondansetron group (42.5%) compared to placebo (70%) (P = 0.013).
- The incidence of itching was lower in the ondansetron group (30%) versus placebo (42.5%), but this difference was not statistically significant (P = 0.245).
Conclusions:
- Ondansetron may be effective in reducing opioid-induced scratching.
- Further research is warranted to confirm the role of ondansetron in managing opioid-induced pruritus.