A Randomized Controlled Trial of Pentazocine Versus Ondansetron for the Treatment of Intrathecal Morphine-Induced Pruritus in Patients Undergoing Cesarean Delivery
เดชา ทำดี, สมรัตน์ จารุลักษณานันท์, ยอดยิ่ง ปัญจสวัสดิ์วงศ์, Chamaiporn Tawichasri, ชยันตร์ธร ปทุมมานนท์, ปิ่น ศรีประจิตติชัย
Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Rama IV Rd., Patumwan, Bangkok 10330, Thailand. Address e-mail:somratcu@hotmail.com.
บทคัดย่อ
BACKGROUND: Ondansetron is effective for the treatment of intrathecal morphine-induced pruritus. There is evidence that κ-opioid receptor agonists have antipruritic activity. Pentazocine is an agonist of κ-opioid receptors and partial agonist at μ-opioid receptors. We therefore performed a randomized, double-blind trial to compare the efficacy of pentazocine and ondansetron for the treatment of pruritus associated with intrathecal injection of morphine in patients undergoing cesarean delivery. METHODS: Two hundred eight parturients who developed moderate to severe pruritus after the administration of intrathecal morphine were randomly allocated to 2 groups: IV pentazocine 15 mg (n = 104) and IV ondansetron 4 mg (n = 104). The successful treatment of pruritus (no or mild pruritus) and other adverse effects were determined 15 min after study drug administration, and patients were observed for recurrence of pruritus for 4 h. RESULTS: The treatment success rate at 15 min was higher in the pentazocine group (96.1%) than in the ondansetron group (80.8%) (95% confidence interval of difference: 7.0%, 23.8%; P = 0.001). The recurrence rate of moderate to severe pruritus within 4 h after treatment in the pentazocine group (12.0%) was lower than in the ondansetron group (32.1%) (P = 0.001). There were no significant differences between groups in nausea/vomiting, sedation, shivering, pain scores, and pain at injection site. No respiratory depression was observed. CONCLUSIONS: Pentazocine 15 mg is superior to ondansetron 4 mg for the treatment of intrathecal morphine-induced pruritus and has a lower recurrence rate. The side effects after treatment are mild.
ที่มา
Anesthesia and Analgesia ปี 2552, November ปีที่: 109 ฉบับที่ 5 หน้า 1606-1611