• Elizabeth M Putnam, Rebecca A Hong, John M Park, Ying Li, Aleda Leis, and Shobha Malviya.
• Department of Anesthesiology, University of Michigan Health System, Ann Arbor, MI, USA.
• Paediatr Anaesth. 2022 Oct 1; 32 (10): 1151-1158.

Study ObjectiveThis study's purpose was to determine if ondansetron can prevent pruritus after administration of intrathecal morphine in children, as has been demonstrated in adults.DesignA double-blinded, randomized placebo-controlled trial.SettingOperating room and first 24 h postoperative inpatient stay at an academic children's hospital.PatientsForty-six children aged 3-17 years, who received 4-5 mcg/kg intrathecal morphine for urological or orthopedic procedures were included.InterventionsChildren were randomized to receive intravenous ondansetron (treatment) or saline placebo (placebo), prior to intrathecal morphine administration, and q6H for 24 h thereafter. Intraoperative anti-emetics and postoperative rescue treatments for pruritus and nausea were standardized.MeasurementsPatients were interviewed q6H for scored pruritus, nausea, and pain, using standardized scales.Main ResultsThe trial was terminated for futility after interim analysis. Forty-six children were recruited and 45 completed data collection. No significant difference was found between both groups for incidence of pruritus (requiring treatment) [relative risk (RR) 0.9, 95% CI: 0.7, 1.2], during the first postoperative 24 h. Notably, the incidence of pruritus was 84% overall, much higher than rates in previously published studies. Intravenous ondansetron significantly reduced the incidence of nausea, compared with the placebo group [RR 0.5, 95% CI: 0.3, 0.9].ConclusionsThis study found no evidence for intravenous ondansetron as an effective preventative for pruritus following intrathecal morphine in children. However, this RCT did find that the rate of pruritus following intrathecal morphine administration may be significantly higher than previously thought. Nausea and vomiting (a secondary outcome) were reduced significantly in the treatment group. The negative findings of this study reinforce the potential dangers of extrapolating the drug effects seen in adults onto pediatric patients.© 2022 The Authors. Pediatric Anesthesia published by John Wiley & Sons Ltd.

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