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The Effect of Ondansetron on Acute Opioid Tolerance in Patients Receiving Intrathecal Opioids Prior to Cesarean Delivery
  1. Kevin C. Greer, MD*,
  2. Abdullah S. Terkawi, MD*,
  3. Siny Tsang, PhD,
  4. Priyanka Singla, MD*,
  5. Marcel E. Durieux, MD, PhD* and
  6. Mohamed Tiouririne, MD*
  1. *Department of Anesthesiology, University of Virginia Health System, Charlottesville, VA; and †Department of Epidemiology, Columbia University, New York, NY
  1. correspondence: Mohamed Tiouririne, MD, Department of Anesthesiology, University of Virginia Health System, PO Box 800710 Charlottesville, VA 22908 (e-mail: mt9y{at}


Background Multiple animal studies suggest that ondansetron ameliorates opioid-induced hyperalgesia and tolerance. In this study, we aimed to determine if the administration of ondansetron prior to spinal anesthesia would have an effect on intrathecal opioid-induced acute opioid tolerance, postoperative pain, and analgesic requirements in patients undergoing cesarean delivery with spinal anesthesia.

Methods Eighty-six patients undergoing elective cesarean delivery were recruited and randomly allocated to receive either 8 mg intravenous ondansetron (n = 44) or placebo (n = 42) in a prospective, double-blind design. All patients received spinal anesthesia consisting of 15 mg bupivacaine, 20 μg of fentanyl, and 100 μg of preservative-free morphine. We used linear mixed-effects models to assess the difference in pain and opioid consumption in the first 24 hours after surgery between the 2 groups.

Results No differences between the 2 groups were found in age, body mass index, American Society of Anesthesiologists physical status scores, duration of surgery, or sensory and motor block characteristics. There was no difference between the 2 groups in postoperative pain scores (P = 0.95) or opioid consumption (P = 0.68).

Conclusions In patients undergoing cesarean delivery under spinal anesthesia with intrathecal opioids, the administration of ondansetron prior to spinal anesthesia did not significantly affect postoperative pain scores or opioid consumption. Thus, the administration of ondansetron did not have an effect on acute opioid tolerance in our study.

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  • The authors declare no conflict of interest. Dr. Tiouririne holds stock in ADial Pharmaceuticals LLC, Charlottesville, VA.

    This work was attributed to the Department of Anesthesiology, University of Virginia, and Department of Epidemiology, Columbia University.

    This study is partially supported by the research training grant 5-T32-MH 13043 from the National Institute of Mental Health (to S.T.).

    This work was presented at the 45th Society of Obstetric Anesthesia and Perinatology Colorado Springs as a poster.