Butorphanol Combined With Ondansetron Impacts Itching By Intrathecal Morphine In Cesarean Section

Objective The current study aims to assess the effects of butorphanol combined with ondansetron on pruritus by intrathecal morphine(IM),providing novel therapeutic methods for IM-related pruritus.Methods This study was approved by the Ethics Committee of Hospital and registered in the Chinese Clinical Trial Registry.From September 2021 to March 2022,456 primiparas were randomly divided into three groups: group B(butorphanol),group O(ondansetron),and group C(butorphanol combined with ondansetron).Time points for observation were set at 4h,8h,12 h and 24 h postoperatively.Primary endpoints were set as the incidence,severity and location of pruritus,while secondary endpoints included Visual Analogue Scale(VAS),Ramsay sedation score(RSS),and Bruggrmann comfort scale(BCS),as well as incidence of nausea,vomiting and respiratory depression,and maternal anesthesia satisfaction.Results 1.Basic characteristics and operation time were similar in all groups(P>0.05).2.Postoperative itching incidence in group B and O was higher than that in group C(P<0.05),while the difference in group B and O remained unsignificant(P>0.05).3.The degree of postoperative pruritus: At 4h,8h and 12 h,the proportion in group C was higher on non-pruritus and lower on mild pruritus than that in Group B and O(P<0.05);At 12 h,the proportion of moderate pruritus in group C decreased compared with group O(P<0.05),Itching severity in all groups at other time points showed no significant difference(P>0.05).4.Itching location occurred on face,trunk and limbs among all groups(P>0.05).As for numerical value,the incidence of facial and limb pruritus in group C was lower,while the incidence of trunk pruritus was higher.5.VAS,RSS and BCS scores at 4h,8h,12 h and 24 h after operation:At 4h and 8h,VAS scores in group B and C were lower than those in group O,while RSS and BCS scores were higher(P<0.05);At 12 h,VAS scores were lower and BCS scores were higher in group B and C than in group O(P<0.05),No significant difference were presented in VAS,RSS and BCS scores among all groups at other timepoints(P>0.05).6.Postoperative complications: There were no puncture site infection,hematoma,hemorrhagic shock,respiratory and cardiac arrest and disseminated intravascular coagulation in the three groups.Nausea and vomiting occurred in 24 patients(16.9%)in group O,29 patients(20.3%)in group B,and 27 patients(18.9%)in group C(P>0.05).Vertigo occurred in 1 case(0.7%)in group O,3 cases(2.1%)in group B,and 5 cases(3.5%)in group C(P>0.05).Respiratory depression occurred in 2 patients(1.4%)in group O,5 patients(3.5%)in group B,and 7 patients(4.9%)in group C(P>0.05).7.No primipara in the three groups were not satisfied with the operation and anesthesia.140 patients(98.6%)in group O,140 patients(98%)in group B,and 141 patients(98.6%)in group C were completely satisfied with the operation and anesthesia(P>0.05).Two patients(1.4%)in group O,3 patients(2%)in group B,and 2 patients(1.4%)in group C were satisfied with the operation and anesthesia(P>0.05).Conclusion1.Butorphanol combined with ondansetron could remarkably impede the occurrence of postoperative pruritus,alleviate the degree of pain and pruritus,and improve the comfort of primipara.2.Butorphanol combined with ondansetron does not aggravate the incidence of adverse events such as nausea,vomiting and respiratory depression,and is safe and worthy for clinical recommendation.