Ondansetron exhibits the properties of a local anesthetic

Evaluation of Peripheral Versus Central Route of Ondansetron as Pretreatment to Prevent Pain on the Injection of Propofol: A Randomized Controlled Study

Objective

We evaluated whether systemic ondansetron was also useful in the attenuation of propofol injection pain similar to ondansetron pretreatment.

Methods

Eighty patients were enrolled. Patients in group S received ondansetron 4 mg in saline in the right hand followed 30 min later by 5 mL saline in the left hand along with venous occlusion. Group L patients received 4 mL of saline in the right hand followed by 5 mL 4 mg ondansetron in the left hand after 30 min. Two minutes later the occlusion was released. Patients received one-fourth of the calculated total dose of propofol, and their level of pain was graded on a scale of 0 to 3, with 0 denoting no discomfort. Mean blood pressure and heart rates were also recorded. Continuous variables were checked for normality using Shapiro-Wilks test. Normal continuous variables were expressed as mean standard deviation and non-normal continuous variables were expressed as median interquartile range. T-test for the difference in the mean and paired test were used for normally distributed continuous variable whereas Mann-Whitney U test-Wilcoxon test and sign test were used for non-normally distributed variables. Repeated measure analysis of variance was used for a variable measured over different periods of time to control for the baseline effect on subsequent measures.

Results

Our results demonstrated that both systemic administration 30 min before and local venous pretreatment with ondansetron were equally beneficial in reducing pain during propofol injection.

Conclusion

A systemic administration of ondansetron may play a role in the attenuation of propofol injection pain.

Involvement of Serotonergic System in Oxaliplatin-Induced Neuropathic Pain

Oxaliplatin is a chemotherapeutic agent widely used against colorectal and breast cancers; however, it can also induce peripheral neuropathy that can rapidly occur even after a single infusion in up to 80–90% of treated patients. Numerous efforts have been made to understand the underlying mechanism and find an effective therapeutic agent that could diminish pain without damaging its anti-tumor effect. However, its mechanism is not yet clearly understood. The serotonergic system, as part of the descending pain inhibitory system, has been reported to be involved in different types of pain. The malfunction of serotonin (5-hydroxytryptamine; 5-HT) or its receptors has been associated with the development and maintenance of pain. However, its role in oxaliplatin-induced neuropathy has not been clearly elucidated. In this review, 16 in vivo studies focused on the role of the serotonergic system in oxaliplatin-induced neuropathic pain were analyzed. Five studies analyzed the involvement of 5-HT, while fourteen studies observed the role of its receptors in oxaliplatin-induced allodynia. The results show that 5-HT is not involved in the development of oxaliplatin-induced allodynia, but increasing the activity of the 5-HT_1A, 5-HT_2A, and 5-HT₃ receptors and decreasing the action of 5-HT_2C and 5-HT₆ receptors may help inhibit pain.

Pharmacokinetic profile of the selective 5-HT3 receptor antagonist ondansetron in the rat: an original study and a minireview of the behavioural pharmacological literature in the rat

The availability of agonists and antagonists to modulate the activity of the 5-hydroxytryptamine (5-HT) type 3 (5-HT3) receptor has renewed interest in its role as a therapeutic target. Ondansetron is a highly selective 5-HT3 receptor antagonist that is well tolerated as an anti-emetic for patients undergoing chemotherapy. Preclinical studies in rat have shown the effects of small doses of ondansetron on cognition, behavioural sensitisation, and epilepsy. However, the pharmacokinetic (PK) profile of ondansetron in rat has not been described, which limits the translational relevance of these findings. Here, we aim to determine, in the rat, the PK profile of ondansetron in the plasma and to determine associated brain levels. The plasma PK profile was determined following acute subcutaneous administration of ondansetron (0.1, 1, and 10 μg/kg). Brain levels were measured following subcutaneous administration of ondansetron at 1 μg/kg. Plasma and brain levels of ondansetron were determined using high-performance liquid chromatography – tandem mass spectrometry. Following administration of all three doses, measured ondansetron plasma levels (≈30–3000 pg/mL) were below levels achieved with doses usually administered in the clinic, with a rapid absorption phase and a short half-life (≈30–40 min). We also found that brain levels of ondansetron at 1 μg/kg were significantly lower than plasma levels, with brain to plasma ratios of 0.45 and 0.46 in the motor and pre-frontal cortices. We discuss our findings in the context of a minireview of the literature. We hope that our study will be helpful to the design of preclinical studies with therapeutic end-points.

The Effect of Granisetron on Sensory Detection and Pain Thresholds in Facial Skin of Healthy Young Males

Background: The specific serotonin type 3 (5-HT₃)-receptor antagonist granisetron effectively reduces clinical as well as experimental muscle pain and hyperalgesia and with a duration that exceeds that of lidocaine. Hence, it may be an alternative to lidocaine as a local anesthetic. There are also some indications that granisetron in addition to 5-HT₃ receptors blocks sodium channels. Thus, the local anesthetic effect by granisetron may resemble that of lidocaine, but this has not been tested. The aim of this study was therefore to compare the effect granisetron has on facial skin sensitivity to the effect of lidocaine and isotonic saline.

Methods: This was a randomized, controlled, and double-blind study, in which 1 ml of either granisetron (test-substance), lidocaine (positive control), or isotonic saline (negative control) was injected into the skin over the masseter muscle at three different occasions in 18 healthy males (27.2 ± 5.8 years old). Skin detection thresholds and pain thresholds for thermal stimuli as well as mechanical detection thresholds and sensitivity to a painful mechanical (pinprick) stimulus were assessed before (baseline) and 5, 20, 40, and 60 min after injection. The quality and area of subjective sensory change over the cheek were assessed 20 min after injection.

Results: All substances increased the mechanical detection threshold (granisetron: p = 0.011; lidocaine: p = 0.016; saline: p = 0.031). Both granisetron and lidocaine, but not isotonic saline, increased the heat detection thresholds (p < 0.001 and p < 0.02, respectively), but not the cold detection thresholds. Granisetron and lidocaine also reduced pinprick pain (p = 0.001 for each comparison). There were no significant differences between granisetron and lidocaine for any of these variables. There was no effect on thermal pain thresholds for any substance.

Conclusion: The similar analgesic patterns on mechanical sensory and pain thresholds as well as thermal sensory thresholds over the facial skin by subcutaneous injection of granisetron and lidocaine shown in this study and the absence of paresthesia, in combination with the reduced pain intensity and pressure pain sensitivity shown in previous studies, indicate that granisetron might be a novel candidate as a local anesthetic.

Comparison the Effect of Granisetron and Dexamethasone on Intravenous Propofol Pain

Background:

The incidence of propofol injection pain during induction of general anesthesia varies from 28% to 90%. This prospective, randomized, double-blind, placebo-controlled study evaluated the effect of dexamethasone and granisetron for reducing the incidence and severity of propofol injection pain.

Materials and Methods:

A total of 227 female subjects received 5 mL of preservative-free saline, 1 mg granisetron (5 ml), or 0.15 mg/kg of dexamethasone (5 ml), intravenously, following exsanguination and occlusion of the veins of the arm. This was followed by a 0.5 mg/kg injection of propofol. Pain scores and intensity of pain recorded immediately following the injection of propofol. Hemodynamic parameters and O₂ sat were recorded 1, 3, 5, and 10 min after propofol injection.

Results:

The incidence pain following the injection of propofol was significantly decreased with both granisetron and dexamethasone (50.7% and 49.4%). Mean pain score in granisetron group was 3.16 ± 1.23, dexamethasone was 2.73 ± 1.03, and in saline group was 4.82 ± 1.73 (P = 0.001). Mean pain intensity in granisetron group was 1.16 ± 0.18, dexamethasone was 1.26 ± 0.14, and in saline group was 2.2 ± 0.99 (P = 0.001). There were no differences in either mean arterial pressure or O₂ Sate at any time point after drugs injection among the groups. There was a significant difference in pulse rate in third minutes between three groups and in the group who received granisetron was lesser (P = 0.04).

Conclusion:

Pretreatment with intravenous granisetron (1 mg) and dexamethasone (0.15 mg/kg) before injection of propofol is effective and safe in reducing the incidence and severity of pain due to propofol injection.

Comparision of Analgesic Efficacy of Tramadol Infusion Versus Tramadol Plus Ondansetron Infusion In Medical Intensive Care Unit

Background:

Tramadol, a preferred analgesic due to its less respiratory depression. It also has a central action that blocks the reuptake and enhances the release of serotonin at spinal antinociceptive pathways. Ondansetron, an antiemetic is a serotonin receptor antagonist. Due to the contradictory actions of the two drugs, co-administration of these drugs resulted in higher usage of tramadol. All these studies were done in the postoperative period.

Aim:

The aim of this study is to evaluate the analgesic efficacy of tramadol infusion versus tramadol plus ondansetron infusion in Medical Intensive Care Unit (ICU) patients.

Materials and Methods:

After Institutional Ethical Committee approval, 50 patients who experience pain other than postoperative pain were enrolled and randomized into two groups. Both the groups initially received 50 mg of tramadol intravenously over 10 min followed by Group T+O received 10 mg/h tramadol + 0.4 mg/h ondansetron as an infusion. Group T received 10 mg/h tramadol as infusion. Hemodynamic parameters along with pain assessment using Verbal Rating Scale (VRS) were analyzed at 0, 3, 6, 12, and 24 h. Rescue analgesia was administered if VRS >4. Side effects were noted by condition scoring criteria (CSC) scale.

Results:

Rescue analgesia was administered at 3 h, for three patients in T+O Group and 1 patient in T Group, but this is not statistically significant (P = 0.153). No rescue analgesia was required in both the groups at any other point of time. There was fall in heart rate, systolic and diastolic blood pressures, respiratory rate at 0, 3, 6, 12, and 24 h in both the groups but not statistically significant. Grade 1 sedation of CSC scale was observed in two patients of Group T+O and one patient in Group T but not statistically significant (P = 0.153). No nausea and vomiting were seen.

Conclusions:

We conclude that co-administration of tramadol and ondansetron can be practiced in medical ICU patients without any higher requirement in dosage of tramadol.

Efficacy of ondansetron for the prevention of propofol injection pain: a meta-analysis

AIM

This review was performed to investigate the effect of ondansetron on the prevention of propofol injection pain.

METHODS

PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) were searched for randomized controlled trials (RCTs) of ondansetron in preventing the pain on injection of propofol. Then, RevMan 5.2 was adopted to conduct a meta-analysis on propofol injection pain.

RESULTS

Ten RCTs, totaling 782 patients, were included in this analysis. The meta-analysis showed that: 1) compared with the control group, the ondansetron group was related to a decreasing incidence of propofol injection pain, and it was statistically significant (risk ratio [RR] = 0.41, 95% confidence interval [CI, 0.34, 0.49], P < 0.00001); 2) compared with the incidence of propofol injection pain in the lidocaine group, there was no difference and no statistical significance (RR = 1.28, 95% CI [0.85, 1.93], P = 0.25); 3) no statistically significant differences were found between the ondansetron and magnesium sulfate groups in the incidence of propofol injection pain (RR = 1.20, 95% CI [0.87, 1.66], P = 0.27); and 4) the incidence of ondansetron group igniting moderate pain (RR = 0.37, 95% CI [0.26, 0.52], P < 0.00001) and severe pain (RR = 0.27, 95% CI [0.17, 0.43] P < 0.00001) was less likely to occur during the injection of propofol compared with the control group, but there was no difference between the ondansetron and control groups in the incidence of mild propofol injection pain (RR = 0.83, 95% CI [0.63, 1.10], P = 0.20).

CONCLUSION

Ondansetron can effectively prevent propofol injection pain, and the effect is similar to that of magnesium sulfate and lidocaine.

A comparative study of attenuation of propofol-induced pain by lignocaine, ondansetron, and ramosetron

Background and Aims:

Propofol is widely used for induction of anaesthesia, although the pain during its injection remains a concern for all anaesthesiologists. A number of techniques have been adopted to minimise propofol-induced pain. Various 5-hydroxytryptamine-3 antagonists have shown to reduce propofol-induced pain. Hence, this placebo-controlled study was conducted to compare the efficacy of ondansetron, ramosetron and lignocaine in terms of attenuation of propofol-induced pain during induction of anaesthesia.

Methods:

Hundred and fifty adult patients, aged 18–60 years, posted for various elective surgical procedures under general anaesthesia were randomly assigned to three groups of 50 each. Group R received 0.3 mg of ramosetron, Group L received 0.5 mg/kg of 2% lignocaine and Group O received 4 mg of ondansetron. After intravenous (IV) pre-treatment of study drug, manual occlusion of venous drainage was done at mid-arm with the help of an assistant for 1 min. This was followed by administration of propofol (1%) after release of venous occlusion. Pain was assessed with a four-point scale. Unpaired Student's t-test and Chi-square test/Fisher's exact test were used to analyse results.

Results:

The overall incidence and intensity of pain were significantly less in Groups L and R compared to Group O (P ≤ 0.001). The incidence of mild to moderate pain in Groups O, R and L was 56%, 26% and 20%, respectively. The incidence of score ‘0’ (no pain) was significantly higher in Group L (76%) and Group R (72%) than Group O (34%) (P < 0.001).

Conclusion:

Pre-treatment with IV ramosetron 0.3 mg is equally effective as 0.5 mg/kg of 2% lignocaine in preventing propofol-induced pain and both were better than ondansetron.

Which one is more efficient on propofol 2% injection pain? Magnesium sulfate or ondansetron: A randomized clinical trial

Background:

Painful sensation has been reported after propofol injection in most of the patients but no definite mechanism for this painful sensation has been proposed yet. The present randomized clinical trial compares analgesic effect of ondansetron, magnesium sulphate (MS) and placebo on patients after propofol 2% injection.

Materials and Methods:

The present randomized clinical trial with parallel design was performed on 90 patients American Society of Anesthesiologists I-II undergoing general anesthesia within vitrectomy operation with propofol induction. Subjects were randomly allocated into three groups with 30 patients each: (1) MS group (2) ondansetron group and (3) normal saline (NS) group as placebo group. Anesthesia induction and maintenance were the same between groups. Pain intensity of propofol injection in subjects was assessed by a four-point scale (none 0, mild 1, moderate 2 and severe 3) at four time intervals (5, 10, 20 and 25 s) after injection.

Results:

MS and ondansetron had significant impacts on pain reduction after propofol 2% injection in comparison with NS as placebo. Comparing two trial groups did not have any significant priority for analgesic impact.

Conclusion:

Using ondansetron or MS had no priority on each other on declining propofol injection induced pain.

Effects of pretreatment with intravenous palonosetron for propofol-remifentanil-based anesthesia in breast and thyroid cancer surgery: a double-blind, randomized, controlled study

Background

We postulated that palonosetron, a novel antiemetic agent, might have the effect of alleviating injection pain from propofol and rocuronium. A double-blind, controlled study was undertaken to evaluate the effect of palonosetron on injection pain during total intravenous anesthesia and postoperative nausea and vomiting (PONV) using propofol-remifentanil in breast and thyroid cancer surgery.

Methods

Sixty patients were randomly allocated to one of two groups. Before injection of propofol and rocuronium, patients in group S (n = 30) received 4 ml of saline and patients in group P (n = 30) received 75 µg (1.5 ml) of palonosetron mixed with 2.5 ml of saline (n = 30). Patients were evaluated by a blinded anesthesiologist with regard to the scoring of injection pain of propofol, withdrawal response by rocuronium, PONV, shivering, postoperative pain, recall of pain, and overall satisfaction.

Results

The differences between groups in the incidence of injection pain due to propofol and rocuronium were insignificant. However, in group P, the severity of propofol-induced injection pain (3% vs. 33%, P = 0.003) and postoperative pain (P = 0.038) was significantly lower during the first 12 h after surgery. No differences were observed between the groups with respect to PONV, shivering, recall of pain, and overall satisfaction.

Conclusions

We concluded that pretreatment of palonosetron was effective to reduce the severity of propofol-induced injection pain and early postoperative pain, although it did not reduce the incidence of injection pain from propofol and rocuronium.

Prevention of propofol injection pain: Comparison between lidocaine and ramosetron

BACKGROUND

Propofol causes a high incidence of pain during intravenous (IV) injection. The aim of this randomized, placebo-controlled, double-blinded study was to determine whether pre-treatment with IV ramosetron, used for prophylaxis of postoperative nausea and vomiting (PONV), would reduce propofol-induced pain as an equivalent to lidocaine.

MATERIALS AND METHODS

Hundred and twenty American Society of Anesthesiologists grade (ASA) I and II patients were randomly assigned into three groups (40 in each). Group N received 2 ml of 0.9% saline, Group L received 2 ml of lidocaine, and Group R received 2 ml of ramosetron. Mid forearm was occluded manually before injection and released after 1 min and then propofol was injected over 5 s. Patients were observed and questioned 15 s later if they had pain in the arm and pain was scored on a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain. Unpaired Student's t-test and chi-square test/Fisher' exact test were used to analyze results.

RESULTS

The incidence of pain in groups N, L, and R were 65, 35, and 30%, respectively. Pain was reduced significantly in the groups L and R (P < 0.05). Two patients each in Groups L and R (5% each) had moderate and severe pain. This difference in pain was statistically insignificant, but when compared to Group N (25 and 30%, respectively) it was statistically significant.

CONCLUSION

Pretreatment with ramosetron 0.3 mg and lidocaine 40 mg are equally effective in preventing pain from propofol injection.

Analgesic effects of palonosetron in the intravenous propofol injection

Background

Propofol is a good induction agent, but it has the disadvantage of causing pain on intravenous injection. The incidence of propofol-induced pain is approximately 70%. Palonosetron is a novel second-generation 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist. We presumed that palonosetron would be effective in reducing the occurrence of propofol-induced pain based on similar mechanisms to other 5-HT3 receptor antagonists.

Methods

Eighty patients were randomized to either Group N (0.9% sodium chloride [normal saline] 2 ml, n = 40) or Group P (palonosetron 0.075 mg, 2 ml, n = 40). Patients were intravenously given a 2 ml pretreatment solution, containing either palonosetron 0.075 mg or normal saline. Following pretreatment with 2 ml of palonosetron 0.075 mg or normal saline, we manually occluded venous drainage midarm with the help of an assistant. One minute later, we released the occlusion of venous drainage. This was followed by a 5-second propofol injection at 25% of the total calculated doses. Patients were then interviewed about whether or not they experienced propofol-induced pain.

Results

Overall, the incidence of propofol-induced pain was 60% in the normal saline group and 27.5% in the palonosetron group. No patients in the palonosetron group experienced severe pain. The incidence of propofol-induced pain was significantly lower in the palonosetron group compared to the normal saline group (P < 0.01).

Conclusions

Following pretreatment with palonosetron, 72.5% of patients experienced a decrease in the occurrence of propofol-induced pain.

A comparison of granisetron and nitroglycerine for attenuating rocuronium pain: A double-blinded randomized, placebo controlled trial

BACKGROUND

The incidence of pain reported in literature after IV administration of rocuronium is 50-80%. The aim of our study was to determine whether pre-treatment with intravenous granisetron and nitroglycerine would reduce rocuronium-induced pain.

METHODS

One hundred fifty patients of either sex, aged 18-65 years, American society of Anaesthesiologist grading (ASA) I-II, scheduled for various surgeries under general anesthesia were randomly assigned to one of the groups. Group G: received 2 granisetron (1mg/ml) diluted with 3 ml of 0.9% normal saline) while the Group C: received 5 ml of 0.9% normal saline. Group N: received 200΅g of nitroglycerine diluted to a total of 5 ml(with 0.9% normal saline). It was accompanied by manual venous occlusion for 20 seconds. Then 0.06mg/kg of rocuronium was injected through same cannula over 10-15 sec. Patients were asked by a blinded investigator to score the pain on injection of rocuronium using visual analogue scale (0-10) with 0-no pain,1-3 mild pain, 4-6 moderate and >=7 severe pain. At the same time discomfort in the form of patient's movement, such as no movement (grade 0), movement only wrist (grade 1), movement to the upper arm and shoulder of injected arm (grade 2) or generalized movements (grade3) was observed. Statistical analysis using independent t test, Mann-Whitney test and reverse ANOVA was done.

RESULTS

1. At 0 seconds, in group G number of patients who experienced withdrawl score of 0-1 were 92%,group N were 82% while only 26% of patients in group C had favourable withdrawl score.74% of patients in group C had score of 2-3 at same time. 2. At 0 sec, in group G number of patients who experienced VAS score of 0-3 were 96%, group N 72%. At same time Group C 48 % of patients had VAS score of 2-3.

CONCLUSION

We conclude that pre-treatment with granisetron or nitroglycerine both are highly effective in attenuation of rocuronium induced pain.

Effect of adding 8 milligrams ondansetron to lidocaine for Bier's block on post-operative pain

BACKGROUND

Ondansetron has analgesic properties. The aim of the present study was to assess the analgesic effect of 8 mg ondansetron when added to lidocaine for intravenous regional anesthesia (IVRA).

MATERIALS AND METHODS

Ninety patients undergoing hand surgery were randomly allocated to the three groups to receive 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL (Group L, n = 30) or 8 mg ondansetron plus 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL (group LO, n = 30) or 3 mg/kg 2% lidocaine diluted with saline to a total dose of 40 mL plus 8 mg ondansetron intravenously (Group IO, n = 30). Tourniquet pain and analgesic use were recorded before and after the tourniquet application.

RESULTS

The sensory and motor block onset times were significantly shorter in Group LO compared with Group L and Group IO (4.2 ± 1.7 vs. 5.2 ± 0.8 and 5.1 ± 1.2 respectively, P < 0.05; 4.5 ± 1.4 vs. 5.8 ± 1.5 and 5.7 ± 1.4 respectively, P < 0.05). The sensory and motor block recovery times were significantly longer in Group LO compared with Group L and Group IO (6.1 ± 1.1 vs. 4.1 ± 1.3 and 4.5 ± 0.9 respectively, P < 0.05; 6.7 ± 1.4 vs. 4.4 ± 0.9 and 4.7 ± 0.7 respectively, P < 0.05). Post-operative VAS scores were significantly less in Group LO compared with Group L and Group IO till 24 h after tourniquet deflation (P < 0.05).

CONCLUSION

The addition of 8 mg ondansetron to lidocaine for IVRA reduced intraoperative and post-operative analgesic use till 24 h.

Pre-treatment with intravenous granisetron to alleviate pain on propofol injection: A double-blind, randomized, controlled trial

Background:

Propofol is one of the widely used intravenous (i.v.) anaesthetics, although pain on injection still remains a considerable concern for the anaesthesiologists. A number of techniques has been tried to minimize propofol-induced pain with variable results. Recently, a 5-HT₃ antagonist, ondansetron pre-treatment, has been shown to reduce propofol-induced pain. The aim of our randomized, placebo-controlled, double-blinded study was to determine whether pre-treatment with intravenous granisetron, which is routinely used in our practice for prophylaxis of post-operative nausea and vomiting, would reduce propofol-induced pain.

Methods:

Eighty-two women, aged 18–50 years, American society of Anaesthesiologist grading (ASA) I–II, scheduled for various surgeries under general anaesthesia were randomly assigned to one of the two groups. One group received 2 mL 0.9% sodium chloride while the other group received 2 mL granisetron (1 mg/mL), and were accompanied by manual venous occlusion for 1 min. Then, 2 mL propofol was injected through the same cannula. Patients were asked by a blinded investigator to score the pain on injection of propofol with a four-point scale: 0=no pain, 1=mild pain, 2=moderate pain, 3=severe pain.

Results:

Twenty-four patients (60%) complained of pain in the group pre-treated with normal saline as compared with six (15%) in the group pre-treated with granisetron. Pain was reduced significantly in the granisetron group (P<0.05). Severity of pain was also lesser in the granisetron group compared with the placebo group (2.5% vs. 37.5%).

Conclusion:

We conclude that pre-treatment with granisetron along with venous occlusion for 1 min for prevention of propofol-induced pain was highly successful.

Prevention of microemulsion propofol injection pain: a comparison of a combination of lidocaine and ramosetron with lidocaine or ramosetron alone

Background

A microemulsion propofol causes a high incidence of pain during intravenous injection. In this study, we investigated the effect of ramosetron on pain induced by microemulsion propofol injection.

Methods

After prospective power analysis and institutional review board approval, a total of 200 ASA I and II patients undergoing general anesthesia were divided into 4 groups. They received one of the following intravenously after tourniquet application on the forearm 1 min before induction of anesthesia using microemulsion propofol; normal saline (Group N, n = 50), lidocaine 20 mg (Group L, n = 50), ramosetron 0.3 mg (Group R, n = 50) and lidocaine 20 mg plus ramosetron 0.3 mg (Group LR, n = 50) diluted into a 5 ml solution. The occlusion was released after 30 seconds and microemulsion propofol was injected over 10-15 seconds. The patients were observed and asked immediately if they had pain in the arm, and their responses were assessed.

Results

The incidence of pain in groups N, L, R and LR was 96%, 76%, 60% and 38%, respectively (P < 0.008). Two patients in Group LR (4.0%) and nine in Group R (18.0%) had moderate to severe pain, which was significantly lower than pain in Groups N (84.0%), L (40.0%) and R (P < 0.008).

Conclusions

Pretreatment with ramosetron 0.3 mg with or without lidocaine 20 mg with a tourniquet on the forearm 30 seconds before the injection of microemulsion propofol is more effective than lidocaine 20 mg or normal saline in preventing pain from a microemulsion propofol injection.

Comparative study of attenuation of the pain caused by propofol intravenous injection, by granisetron, magnesium sulfate and nitroglycerine

Background:

Propofol has the disadvantage of causing pain or discomfort on injection. The aim of the study was to assess the efficacy of pretreatment with various drugs to alleviate the propofol injection pain.

Methods:

One hundred American Society of Anesthesiology (ASA) I and II adults, scheduled for various elective surgical procedures under general anesthesia (GA), were included in the study. They were randomly divided into four groups having 25 patients in each group. Group A received pretreatment with intravenous (i.v.) magnesium sulfate, group B received i.v. granisetron, group C received i.v. nitroglycerine and group D was the control group. One-fourth of the total calculated induction dose of propofol was administered over a period of 5 seconds. The patients were asked about the pain on injection. The intensity of pain was assessed using verbal response. A score of 0–3 which corresponds to no, mild, moderate and severe pain was recorded.

Results:

All the three drugs reduced the incidence and intensity of pain on propofol injection but the order of efficacy in attenuation of pain on the propofol injection was granisetron > nitroglycerine > magnesium sulfate > control.

Conclusion:

Granisetron was the most effective followed by nitroglycerine and magnesium sulfate in attenuating pain on propofol intravenous injection.

Pain on injection of propofol: the effect of granisetron pretreatment

OBJECTIVE

To assess the effect of granisetron pretreatment in alleviating propofol injection pain.

STUDY DESIGN

A randomized, controlled, double-blind study, using venous retention with a tourniquet.

MATERIALS AND METHODS

One hundred fifty adult patients were randomly assigned to one of three groups: group 1 (who received 5 mL of 0.9% saline pretreatment), group 2 (who received 5 mL lidocaine [40 mg in 0.9% saline] pretreatment), and group 3 (who received 5 mL granisetron [2 mg in 0.9% saline] pretreatment). Injections were given in the largest vein on the dorsum of the hand. After 2 minutes, the tourniquet was released and one fourth of the total calculated dose of propofol (2.5 mg/kg body weight) was administered and pain assessment was made.

RESULTS

Lidocaine and granisetron significantly reduced the incidence and severity of propofol injection pain more than placebo (P < 0.001). The efficacy of granisetron in alleviating the pain on injection of propofol was no different from lidocaine.

CONCLUSIONS

Granisetron pretreatment may be used to reduce the incidence of pain on injection of propofol, an advantage added to the useful prevention of postoperative nausea and vomiting.

Ondansetron versus diclofenac sodium in the treatment of acute ureteral colic: a double blind controlled trial

The aim of this study is to compare the effectiveness of the 5-HT3 antagonist, ondansetron and a non-steroidal anti-inflammatory agent, diclofenac sodium, as a pain reliever in the treatment of acute ureteral colic. Sixty four patients with severe or moderate pain who were clinically diagnosed as having ureteral colic associated with microscopic or gross hematuria were included in the study. Thirty three patients were administered ondansetron and 31 patients were administered diclofenac sodium. Exclusion critera were known kidney or liver disease causing dysfunction, known hypersensitivity to ondansetron or diclofenac sodium, pregnancy, lactation, duodenal ulcer or bleeding. After pain assessment with a verbal scale and a visual analog scale (VAS), we randomized patients and administered 8 mg ondansetron intravenously to 33 patients and 75 mg diclofenac sodium intramuscularly to 31 patients and pain scores were recorded every 15 minutes. If significant pain relief was not achieved within 60 minutes, i.v. meperidine was given as rescue pain medication. Ondansetron was effective as a primary pain reliever in 14 (42.4%) patients, whereas 19 patients required additional medication. Diclofenac sodium was effective as a primary pain reliever in 24 (77.4%) patients, whereas 7 patients required additional medication. Ondansetron was not superior to diclofenac sodium in relieving pain in patients with acute ureteral colic.

Ondansetron: a selective 5-HT(3) receptor antagonist and its applications in CNS-related disorders

Ondansetron is a selective 5-hydroxytryptamine(3) (5-HT(3)) receptor antagonist that has been introduced to clinical practice as an antiemetic for cancer treatment-induced and anesthesia-related nausea and vomiting. Its use under these circumstances is both prophylactic and therapeutic. It has a superior efficacy, safety and pharmacoeconomic profile compared with other groups of antiemetics, namely antidopaminergics, antihistamines and anticholinergics. However, its place in the management of anticipatory and delayed vomiting in cancer treatment and as a rescue antiemetic in surgical patients needs to be further explored. Furthermore, recent animal and human research also reflects its possible novel application in the treatment of other disease states, such as alcoholism, cocaine addiction, opioid withdrawal syndrome, anxiety disorders, gastrointestinal motility disorders, Tourette's syndrome and pruritus. This review revisits the widespread physiological and pathological effects of 5-HT and discusses both the basic science literature and the clinical developments responsible for the conventional and novel uses of ondansetron. In addition, new discoveries relating to the effects of ondansetron on other receptors/channels and their possible therapeutic applications are presented.