The effect of ondansetron on analgesic efficacy of acetaminophen after hysterectomy: A randomized double blinded placebo controlled trial

J Clin Anesth. 2017 Aug:40:78-83. doi: 10.1016/j.jclinane.2017.03.049.


Objectives: To determine that perioperative ondansetron reduces the analgesic efficacy of acetaminophen.

Design: Randomized, double-blinded study.

Patients: 120 patients ASA I-II who underwent abdominal hysterectomy.

Interventions: All the patients were given 1g acetaminophen at skin closure. Patients were divided into two groups; ondansetron HCl (8mg, 2ml IV) (Group I, N=60) and saline (2ml IV) (Group II, N=60) at the skin closure.

Measurement: Postoperative pain scores (VAS) while resting in bed and sitting, total opioid consumption were noted.

Main results: Patients randomized to ondansetron had significantly worse pain scores upon arrival to the recovery unit [by 1.7 (99.7% CI: 0.75, 2.59) cm] and at 1h [by 1.3 (0.5, 2.1) cm] while resting in bed. Pain scores while sitting were also significantly greater in ondansetron group at arrival in PACU by 0.6 (99.7% CI: 0.1, 1.0) cm. Thereafter, pain scores did not differ significantly. Median total opioid (tramadol) consumption was 441 [Q1, Q3: 280, 578] mg in the ondansetron group and 412 [309, 574] mg in the placebo group, P=0.95.

Conclusions: Ondansetron significantly decreased the analgesic effect of acetaminophen during the initial postoperative period. Our results thus confirm that acetaminophen analgesia is partially mediated by serotonin receptors. However, the reduction was of marginal clinical importance and short-lived.

Keywords: Abdominal hysterectomy; Acetaminophen; Anesthesia; Postoperative pain; Serotonergic pathway.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetaminophen / antagonists & inhibitors*
  • Acetaminophen / therapeutic use
  • Adult
  • Analgesics, Non-Narcotic / therapeutic use*
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / therapeutic use
  • Antiemetics / pharmacology*
  • Antiemetics / therapeutic use
  • Double-Blind Method
  • Drug Administration Schedule
  • Drug Interactions
  • Female
  • Hemodynamics / drug effects
  • Humans
  • Hysterectomy / adverse effects*
  • Middle Aged
  • Ondansetron / pharmacology*
  • Ondansetron / therapeutic use
  • Pain Measurement / methods
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / prevention & control*
  • Postoperative Nausea and Vomiting / prevention & control
  • Postoperative Period
  • Tramadol / administration & dosage
  • Tramadol / therapeutic use


  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Antiemetics
  • Acetaminophen
  • Tramadol
  • Ondansetron