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Effect of Prophylactic Ondansetron on the Incidence of Spinal Anesthesia-Induced Shivering and Hypotension in Elective Cesarean Sections: Double-Blind, Placebo-Controlled, Randomized Clinical Trial

Author(s): Ahmad M Salahat, Adham Abu Taha, Nouraldin Almasri, Essa Sweity and Saed H, Zyoud

Background: Spinal anesthesia is the preferred method of anesthesia during cesarean section; nonetheless, it is associated with serious side effects both on mother and fetus, including spinal anesthesia-induced shivering and hypotension. Previous research suggests that serotonin may have a role in the occurrence of hypotension, bradycardia, and shivering perioperatively. We investigated the efficacy of ondansetron, a serotonin receptor antagonist, on the incidence of spinal anesthesia-induced shivering, hypotension, nausea, vomiting, and other potential problems in elective cesarean sections in this prospective double-blind randomized control trial research. This study was carried out in Palestine, West Bank, Nablus city, at the cesarean section surgery rooms and post-anesthesia care unit at Rafidia governmental hospital. Eighty full-term elective cesarean section parturients (Age 18-50 years) with ASA 1 or 2 were recruited and randomly assigned to one of two groups: prophylactic IV ondansetron group and placebo 0.9 % saline control. The incidence of spinal anesthesia-induced shivering and hypotension were the primary outcomes, whereas the secondary outcomes were perioperative bradycardia, nausea, vomiting, headache, pain, pruritus, dizziness, respiratory depression, and parturient satisfaction. Results: Intraoperatively, the incidence of intraoperative hypotension and dizziness was significantly lower in the ondansetron group than in the control group (22.5 % vs. 62.5 %, respectively; P< 0.001), as were the incidences and intensity of intraoperative shivering was lower than the control group (12.5 % vs. 32.5 %, respectively; P = 0.032). The intensity of intraoperative nausea was lower in the ondansetron group than in the control group (P = 0.049). Postoperatively, the incidence of postoperative dizziness was lower in the ondansetron group than in the control group (5 % vs. 37.5 %, respectively; P = 0.001), as did the incidence and intensity of postoperative shivering (12.5 % vs. 37.5 %, respectively; P = 0.01). The incidence and severity of postoperative nausea were lower in the ondansetron group than in the control group (17.5 % vs. 40 %, respectively; P = 0.026), as did the incidence of postoperative vomiting (25.5 % vs. 2.5 %, respectively; P = 0.014). Conclusion: Prophylactic 4 mg IV ondansetron can considerably reduce the occurrence of spinal anesthesia-induced shivering and hypotension, dizziness, nausea, and vomiting, and enhance the parturient favorable rating in cesarean section clients.

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