Zofran for morphine-induced itching?

Just a CRNA · Dec 1, 2004

I had a T9-L1 spinal fusion patient today with an epidural. I contacted the pain management team for itching and he ordered Zofran, stating that his itching was due more to opiod receptor action rather than histamine release. Since I know morphine to be a histamine releaser, I was confused by a direct receptor-mediated pruritis. I also had a visit by two PharmD who were also unaware of this use for Zofran. His itching stopped, but he also got Benadryl and a switch to epidural Dilaudid shortly afterwards, so I'm not sure what fixed him?
Anybody using Zofran for epidural itching?

A very small dose of Narcan (0.1 mg) or so works well for pruritis without really affecting the analgesic component of epidural narcotics.

jwk · Dec 1, 2004

I had a T9-L1 spinal fusion patient today with an epidural. I contacted the pain management team for itching and he ordered Zofran, stating that his itching was due more to opiod receptor action rather than histamine release. Since I know morphine to be a histamine releaser, I was confused by a direct receptor-mediated pruritis. I also had a visit by two PharmD who were also unaware of this use for Zofran. His itching stopped, but he also got Benadryl and a switch to epidural Dilaudid shortly afterwards, so I'm not sure what fixed him?
Anybody using Zofran for epidural itching?

We do THOUSANDS of post op epidurals a year. Zofran doesn't enter into the picture for itching.

mwbeah · Dec 1, 2004

I had a T9-L1 spinal fusion patient today with an epidural. I contacted the pain management team for itching and he ordered Zofran, stating that his itching was due more to opiod receptor action rather than histamine release. Since I know morphine to be a histamine releaser, I was confused by a direct receptor-mediated pruritis. I also had a visit by two PharmD who were also unaware of this use for Zofran. His itching stopped, but he also got Benadryl and a switch to epidural Dilaudid shortly afterwards, so I'm not sure what fixed him?
Anybody using Zofran for epidural itching?

Management of opioid-induced pruritus: a role for 5-HT3 antagonists?

K. Kyriakides, S. K. Hussain and G. J. Hobbs

University Department of Anaesthesia, Queen's Medical Centre, University Boulevarde, Nottingham NG7 2UH, UK 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.

also

Prophylactic Ondansetron Reduces the Incidence of Intrathecal Fentanyl-Induced Pruritus

Anesth. Analg., December 1, 2002; 95(6): 1763 - 1766

BigDave · Dec 1, 2004

Thanks!

I've heard of small dose Narcan being used and it mentioned it in my baby miller, so I guess the receptor-mediated response is valid. I'll pass that study on to my pharmD guys.

yoga crna · Dec 2, 2004

It is an interesting concept, but Zofran is a very expensive drug. Benadryl is inexpensive and works well. Personally, I use nalbuphine (nubain) because it is an angonist/antagonist drug which reverses the side-effects of the opiods, while providing analgesia.

I know the pharmaceuticals want us to use the newest and most expensive drugs, when then older and less expensive work just as well. In private practice, I have to keep tabs on the prices and as owner of a surgery center, it can have a major impact on my bottom line.

On a personal note, I had a morphine PCA pump after major abdominal surgery and had a major histamine response. I would have rather had the pain than that feeling. My bright CRNA colleague, stopped the MS, gave me Nubain and benadryl and I felt 100% better.

Yoga

renerian, BSN, RN · Dec 2, 2004

Thanks for posting it. I enjoy reading and learning more.

renerian

jwk · Dec 2, 2004

It is an interesting concept, but Zofran is a very expensive drug. Benadryl is inexpensive and works well. Personally, I use nalbuphine (nubain) because it is an angonist/antagonist drug which reverses the side-effects of the opiods, while providing analgesia.
I know the pharmaceuticals want us to use the newest and most expensive drugs, when then older and less expensive work just as well. In private practice, I have to keep tabs on the prices and as owner of a surgery center, it can have a major impact on my bottom line.
On a personal note, I had a morphine PCA pump after major abdominal surgery and had a major histamine response. I would have rather had the pain than that feeling. My bright CRNA colleague, stopped the MS, gave me Nubain and benadryl and I felt 100% better.
Yoga

That's probably why we're not using it as well. Our pharmacy staff deals with most of the drug reps now. Half the time they never make it past their door. Benadryl is a lot cheaper than Zofran - I doubt we'd change.

Tenesma · Dec 2, 2004

zofran is a good option.... but not necessarily a cheap one...

BigDave · Dec 3, 2004

Great...so we're wasting more taxpayer's money! Go Air Force!