Objective To evaluate the effects of prophylactic ondansetron for preventing intrathecal opioid induced pruritus. Methods According to the Cochrane Handbook, such databases as The Cochrane Library, OVID, EMbase, PubMed, CNKI and CBM were searched to collect the randomized controlled trials (RCTs) about ondansetron for preventing intrathecal opioid induced pruritus. According to the predefined inclusion and exclusion criteria, the literatures were screened, and meta-analysis was conducted by using RevMan 5.0 software. Results Eight RCTs involving 577 patients were included. The quality evaluation showed the bias of all studies was unclear. Meta-analysis showed that because the heterogeneity of the included studies was so large (P=0.0001, I2=80%), subgroup analyses were performed. The subgroup analyses on surgery methods showed no statistical heterogeneity among all subgroups. a) There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in arthroscopic knee or urologic surgery (RR=0.49, 95%CI 0.35 to 0.67); b) There was no significant difference in incidence rate of pruritus between the ondansetron group and the control group in obstetric surgery (RR=0.98, 95%CI 0.86 to 1.12); c) There was a significant difference in incidence rate of pruritus between the ondansetron group and the control group in gynecologic surgery (RR=0.51, 95%CI 0.34 to 0.76); and d) There was no significant difference in the incidence rate of pruritus between the ondansetron group and the control group in outpatient surgery (RR=0.49, 95%CI 0.35 to 0.67). Conclusion The subgroup analyses performed because of the large heterogeneity of the included studies indicate that ondansetron can prevent the intrathecal opioid induced pruritus in arthroscopic knee, urologic and gynecological surgeries rather than obstetric and outpatient surgeries. Due to the small scale, large heterogeneity and unclear quality evaluation of the included studies, more high quality RCTs are required to provide reliable evidence.
ObjectiveTo evaluate the effectiveness and safety of prophylactic ondansetron for the prevention of postoperative shivering. MethodsAccording to the Cochrane Handbook, we searched such databases as Cochrane Library, PubMed, OVID, EMbase, CNKI, CBM, and VIP (From January 1999 to September 2013) to collect the literature about ondansetron for the prevention of postoperative shivering. According to the predefined inclusion and exclusion criteria, we screened randomized controlled trials (RCTs). The included studies were evaluated and analyzed by meta-analysis with RevMan 5.0 software. ResultsNine RCTs involving 655 patients were included. The results of meta-analysis showed that there was a significant difference in incidence of postoperative shivering between group ondansetron and the controls [RR=0.32, 95%CI (0.24, 0.42), P<0.05]. There was a significant difference in incidence of postoperative nausea and vomiting between the ondansetron group and the control group [RR=0.30, 95%CI (0.14, 0.63), P<0.05]. There was no significant difference in the 1 min and 5 min neonate born Apgar score between the ondansetron group and the control group [WMD=0.03, 95%CI (-0.02, 0.09), P=0.26; WMD=-0.02, 95%CI (-0.12, 0.08), P=0.68]. ConclusionIntravenous ondansetron before surgery can significantly reduce postoperative shivering without any increment of adverse effects.