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Serotonin receptor antagonists for the prevention and treatment of pruritus, nausea, and vomiting in women undergoing cesarean delivery with intrathecal morphine: a systematic review and meta-analysis.

Publication ,  Journal Article
George, RB; Allen, TK; Habib, AS
Published in: Anesth Analg
July 2009

BACKGROUND: We performed a systematic review to determine the overall efficacy of serotonin (5-HT3) receptor antagonists for the prevention and treatment of pruritus, nausea, and vomiting in women receiving spinal anesthesia with intrathecal morphine for cesarean delivery. METHODS: Reports of randomized, controlled trials that compared prophylaxis or treatment of pruritus and/or nausea, and vomiting using one of the 5-HT3 receptor antagonists or placebo in women undergoing cesarean delivery were reviewed. The articles were scored for validity and data were extracted by the authors independently and summarized using relative risks (RR) with 95% confidence intervals (CI). RESULTS: Nine randomized, controlled trials were included in the systematic review. The nine trials had a total of 1152 patients enrolled; 539 received 5-HT3 receptor antagonists, 413 received placebo, and 200 received other antiemetics and were not included in the analysis. The incidence of pruritus was not reduced with 5-HT3 receptor antagonists prophylaxis compared with placebo (80.7% vs 85.8%, RR [95% CI] = 0.94 [0.81-1.09]). However, their use reduced the incidence of severe pruritus and the need for treatment of pruritus (number-needed-to-treat = 12 and 15, respectively). Their use for the treatment of established pruritus showed improved efficacy compared with placebo with a number-needed-to-treat of three. There was a significant reduction in the incidence of postoperative nausea (22.0% vs 33.6%, RR [95% CI] = 0.75[0.58-0.96]) and vomiting (7.7% vs 16.8%, RR [95% CI] = 0.49 [0.30-0.81]), and the need for postoperative rescue antiemetic treatment with the use of 5-HT(3) receptor antagonists when compared with placebo (9% vs 23%, RR [95% CI] = 0.38 [0.21-0.68]). CONCLUSIONS: Although prophylactic 5-HT(3) receptor antagonists were ineffective in reducing the incidence of pruritus, they significantly reduced the severity and the need for treatment of pruritus, the incidence of postoperative nausea and vomiting, and the need for rescue antiemetic therapy in parturients who received intrathecal morphine for cesarean delivery. They were also effective for the treatment of established pruritus. Although more studies are warranted, the current data suggest that the routine prophylactic use of those drugs should be considered in this patient population.

Duke Scholars

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

July 2009

Volume

109

Issue

1

Start / End Page

174 / 182

Location

United States

Related Subject Headings

  • Serotonin Antagonists
  • Serotonin 5-HT3 Receptor Antagonists
  • Receptors, Serotonin, 5-HT3
  • Pruritus
  • Pregnancy
  • Postoperative Nausea and Vomiting
  • Morphine
  • Injections, Spinal
  • Humans
  • Female
 

Citation

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George, Ronald B., Terrence K. Allen, and Ashraf S. Habib. “Serotonin receptor antagonists for the prevention and treatment of pruritus, nausea, and vomiting in women undergoing cesarean delivery with intrathecal morphine: a systematic review and meta-analysis.Anesth Analg 109, no. 1 (July 2009): 174–82. https://doi.org/10.1213/ane.0b013e3181a45a6b.

Published In

Anesth Analg

DOI

EISSN

1526-7598

Publication Date

July 2009

Volume

109

Issue

1

Start / End Page

174 / 182

Location

United States

Related Subject Headings

  • Serotonin Antagonists
  • Serotonin 5-HT3 Receptor Antagonists
  • Receptors, Serotonin, 5-HT3
  • Pruritus
  • Pregnancy
  • Postoperative Nausea and Vomiting
  • Morphine
  • Injections, Spinal
  • Humans
  • Female