Comparison of the Effectiveness of Nalbuphine Versus Ondansetron for Prevention of Intrathecal Opioid Induced Pruritus after Cesarean Delivery: A Randomized Controlled Trial
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Abstract
BACKGROUND: Spinal anesthesia with intrathecal opioid is a common technique used to alleviate pain and minimize blood loss during cesarean delivery. However, a common side effect of opioids is pruritus, which typically does not respond to antihistamine drugs and can cause discomfort for patients after anesthesia.
OBJECTIVE: This study aimed to compare the efficacy of nalbuphine with ondansetron in preventing pruritus after cesarean delivery.
METHODS: A double-blind randomized controlled trial was conducted between July 2024 and September 2024 involving 94 patients undergoing cesarean sections. The patients received spinal anesthesia with 0.2 mg of morphine. They were randomly assigned to two groups of 47, receiving either nalbuphine or ondansetron after delivery. Outcomes related to pruritus, nausea/vomiting, pain, and sedation score were assessed in the recovery room and at 6 and 24 hours post-anesthesia. Data were obtained using statistical analysis and was conducted using Descriptive Statistics, Fisher’s Exact Test, Independent t-test or Mann-Whitney U Test and Friedman Test.
RESULTS: The incidence of pruritus in the nalbuphine group was reduced significantly compared to the ondansetron group in the recovery room and at 24 hours post-anesthesia (10.6% vs. 31.9%, p=0.01; 0% vs. 8.5%, p=0.04, respectively). Additionally, the incidence of nausea and vomiting in the recovery room was significantly higher in the nalbuphine group compared to the ondansetron group (14.9% vs. 2.1%, p=0.03). There were no statistically significant differences in pain and sedation scores between the two groups.
CONCLUSIONS: Nalbuphine is effective in preventing pruritus associated with spinal analgesia in patients undergoing cesarean delivery. However, a common side effect is nausea and vomiting, which suggests that it should be used in conjunction with ondansetron to reduce the incidence of these symptoms.
Thaiclinicaltrials.org number, TCTR20241022009
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