The Effect of Ondansetron on Acute Opioid Tolerance in Patients Receiving Intrathecal Opioids Prior to Cesarean Delivery

• Published in: Regional anesthesia and pain medicine Vol. 42; no. 5; pp. 669 - 673
• Main Authors: Greer, Kevin C, Terkawi, Abdullah S, Tsang, Siny, Singla, Priyanka, Durieux, Marcel E, Tiouririne, Mohamed
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.09.2017
• Subjects: Adult; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Anesthesia; Anesthesia, Spinal - adverse effects; Anesthesia, Spinal - methods; Cesarean section; Cesarean Section - adverse effects; Double-Blind Method; Drug Tolerance; Elective Surgical Procedures; Female; Fentanyl - administration & dosage; Fentanyl - adverse effects; Humans; Hyperalgesia; Infusions, Intravenous; Injections, Spinal; Linear Models; Narcotics; Ondansetron - administration & dosage; Ondansetron - adverse effects; Pain; Pain Measurement; Pain, Postoperative - diagnosis; Pain, Postoperative - etiology; Pain, Postoperative - physiopathology; Pain, Postoperative - prevention & control; Pregnancy; Prospective Studies; Regional anesthesia; Serotonin Antagonists - administration & dosage; Serotonin Antagonists - adverse effects; Time Factors; Treatment Outcome; Virginia
• ISSN: 1098-7339; 1532-8651
• DOI: 10.1097/AAP.0000000000000642

Multiple animal studies suggest that ondansetron ameliorates opioid-induced hyperalgesia and tolerance. In this study, we aimed to determine if the administration of ondansetron prior to spinal anesthesia would have an effect on intrathecal opioid-induced acute opioid tolerance, postoperative pain, and analgesic requirements in patients undergoing cesarean delivery with spinal anesthesia. Eighty-six patients undergoing elective cesarean delivery were recruited and randomly allocated to receive either 8 mg intravenous ondansetron (n = 44) or placebo (n = 42) in a prospective, double-blind design. All patients received spinal anesthesia consisting of 15 mg bupivacaine, 20 μg of fentanyl, and 100 μg of preservative-free morphine. We used linear mixed-effects models to assess the difference in pain and opioid consumption in the first 24 hours after surgery between the 2 groups. No differences between the 2 groups were found in age, body mass index, American Society of Anesthesiologists physical status scores, duration of surgery, or sensory and motor block characteristics. There was no difference between the 2 groups in postoperative pain scores (P = 0.95) or opioid consumption (P = 0.68). In patients undergoing cesarean delivery under spinal anesthesia with intrathecal opioids, the administration of ondansetron prior to spinal anesthesia did not significantly affect postoperative pain scores or opioid consumption. Thus, the administration of ondansetron did not have an effect on acute opioid tolerance in our study.