The role of ondansetron in prevention of post-spinal shivering (PSS) in obstetric patients: A double-blind randomized controlled trial
Background: Elective cesarean delivery (C/D) under neuraxial anesthesia is commonly associated with shivering. Ondansetron is a widely used antiemetic during both pregnancy and surgery. Few controversial studies investigated its anti-shivering effect in C/D under spinal anesthesia. Objectives: To study the efficacy of ondansetron to prevent post-spinal shivering in parturients underwent cesarean delivery under spinal Anesthesia. Methods: This double-blinded, prospective, randomized, trial included 80 parturients underwent C/D under spinal anesthesia, randomized into two equal groups [40 patients each]; group O [Ondansetron]: received 8mg/4ml ondansetron and group S [Saline] received 4ml normal saline as placebo. Post-spinal shivering and maximum shivering at any time were recorded on a (0-4) scale and total meperidine dose required to treat shivering at score≥3, was calculated. Maternal MAP assessed before spinal anesthesia (T 0 ), just after spinal and lateral tilt positioning (T 1 ), 2min after positioning (T 2 ), 5min after positioning (T 3 ), Just after delivery of the baby (T 4 ), at the end of surgery (T 5 ), together with total ephedrine (required to treat any hypotension) were recorded. Incidence of nausea and vomiting at any time during surgery was also recorded. Results: Incidence of shivering, maximum shivering, total meperidine dose and incidence of nausea were lower in ondansetron group compared to saline group. Maternal MAP was lower at (T 3 ) in placebo group, without difference in the total ephedrine dose between the two study groups. Conclusion: Ondansetron (8mg) was effective in reducing post-spinal shivering in parturients underwent elective cesarean delivery and decreasing the requirement to meperidine together with lower incidence of post-spinal hypotension and nausea when compared to placebo (saline).
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