Document Type : Original Article



Objective: Pruritus is a common and disturbing side effect of neuraxial opioids after 
cesarean section. The purpose of this study was to compare the efficacy of intravenous 
ondansetron and sub-hypnotic dose of propofol in control and treatment of intrathecal 
sufentanil induced pruritus in cesarean surgery.
Methods: Totally, 90 parturient with American Society of Anesthesiology physical status 
grade I-II, undergoing spinal anesthesia with 2.5 µg sufentanil and 10 mg bupivacaine 0.5% were 
enrolled to this randomized, prospective, double-blind study. The women were randomly 
assigned to two groups who received 8 mg ondansetron or 10 mg propofol to treat pruritus 
grade ≥3. The patient was evaluated after 5 min and in the lack of successful treatment, 
the doses of two drugs repeated and if the pruritus is on-going, the exact treatment with 
naloxone was done.
Findings: The incidence of pruritus was 69.3%. Both groups were well-matched. The 
peak time pruritus was 30–75 min after injection. The percentage of individuals consumed 
naloxone were 6.8% and 15.9% in ondansetron and propofol groups, respectively (P = 0.18). 
The mean score of satisfaction (according to visual analog scale criteria) was 9.09 ± 1.1 in 
ondansetron group and 9.3 ± 1.07 in the propofol group (P = 0.39).
Conclusion: Ondansetrone and sub-hypnotic dose of propofol are both safe and 
well‑tolerated. Due to their same efficacy in the treatment of intrathecal sufentanil‑induced 
pruritus, they can be widely used in clinical practice.


1. Birnbach DJ, Ingrid M. Anesthesia for obstetrics. In: Miller RD, 
editor. Text Book of Anesthesia. Philadelphia: Chuchil 
Livingstone; 2010. p. 2215, 9.
2. Norris MC. Height, weight, and the spread of subarachnoid 
hyperbaric bupivacaine in the term parturient. Anesth Analg 
3. Santos AC, Buklin BA. Local anesthetics and opioids. In: 
David H, editor. Chestnut Obstetric Anesthesia. Philadelphia 
PA 19103-2899: Mosby, Elsevier; 2014. p. 284.
4. Cohen SE, Cherry CM, Holbrook RH Jr, el‑Sayed YY, 
Gibson RN, Jaffe RA. Intrathecal sufentanil for labor 
analgesia – sensory changes, side effects, and fetal heart rate 
changes. Anesth Analg 1993;77:1155‑60.
5. Gowan JD, Hurtig JB, Fraser RA, Torbicki E, Kitts J. Naloxone 
infusion after prophylactic epidural morphine: Effects 
on incidence of postoperative side‑effects and quality of 
analgesia. Can J Anaesth 1988;35:143‑8.
6. Borgeat A, Wilder‑Smith OH, Suter PM. The nonhypnotic 
therapeutic applications of propofol. Anesthesiology 
7. Liu S, Chiu AA, Carpenter RL, Mulroy MF, Allen HW, 
Neal JM, et al. Fentanyl prolongs lidocaine spinal anesthesia 
without prolonging recovery. Anesth Analg 1995;80:730‑4.
8. Liu SS. Optimizing spinal anesthesia for ambulatory surgery. 
Reg Anesth 1997;22:500‑10.
9. Ben‑David B, Solomon E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small‑dose dilute bupivacaine: 
Better anesthesia without prolonging recovery. Anesth Analg 
10. Szarvas S, Harmon D, Murphy D. Neuraxial opioid‑induced 
pruritus: A review. J Clin Anesth 2003;15:234‑9.
11. Bromage PR, Camporesi EM, Durant PA, Nielsen CH. 
Nonrespiratory side effects of epidural morphine. Anesth 
Analg 1982;61:490‑5.
12. Hu JW, Dostrovsky JO, Sessle BJ. Functional properties of 
neurons in cat trigeminal subnucleus caudalis (medullary 
dorsal horn). I. Responses to oral‑facial noxious and 
nonnoxious stimuli and projections to thalamus and 
subnucleus oralis. J Neurophysiol 1981;45:173‑92.
13. Borgeat A, Wilder‑Smith OH, Saiah M, Rifat K. Subhypnotic 
doses of propofol relieve pruritus induced by epidural and 
intrathecal morphine. Anesthesiology 1992;76:510‑2.
14. Ikoma A, Rukwied R, Ständer S, Steinhoff M, Miyachi Y, 
Schmelz M. Neurophysiology of pruritus: Interaction of itch 
and pain. Arch Dermatol 2003;139:1475‑8.
15. GeorgeRB, Allen TK, HabibAS. 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 2009;109:174‑82.
16. Dahlgren G, Hultstrand C, Jakobsson J, Norman M, ErikssonEW, 
Martin H. Intrathecal sufentanil, fentanyl, or placebo added to 
bupivacaine for cesarean section. Anesth Analg 1997;85:1288‑93.
17. Ganesh A, Maxwell LG. Pathophysiology and management 
of opioid‑induced pruritus. Drugs 2007;67:2323‑33.
18. Rawal N, Sjöstrand U, Dahlström B. Postoperative pain relief 
by epidural morphine. Anesth Analg 1981;60:726‑31.
19. Kumar K, Singh SI. Neuraxial opioid‑induced pruritus: An 
update. J Anaesthesiol Clin Pharmacol 2013;29:303‑7. 
20. Beilin Y, Bernstein HH, Zucker‑Pinchoff B, Zahn J, Zenzen WJ. 
Subhypnotic doses of propofol do not relieve pruritus induced 
by intrathecal morphine after cesarean section. Anesth Analg