A comparative study between intravenous Ondansetron and Granisetron in attenuation of hypotension during spinal anaesthesia in patients undergoing caesarean section

Abstract

Hypotension is most common intraoperative complication after spinal anesthesia during cesarean delivery. The Bezold-Jarisch reflex is one of the causes for occurrence of hypotension after spinal anesthesia through serotonin with decreased blood volume. Our aim of this study was to compare the two serotonin receptor antagonists Ondansetron and Granisetron to prevent spinal induced hypotension and bradycardia after spinal anesthesia in parturients undergoing cesarean sections. Materials and Methods: 90 patients of ASA class-I and II, aged 20-40years, weight 40-80kilograms were included in this study. Patient with history of PIH, convulsion, any major comorbidity were excluded from study. Patients were assigned into 3 groups group A received 4 mg Ondansetron intravenously, group B received 1 mg Granisetron intravenously and group C received 10 ml of intravenous normal saline 5 min before spinal anaesthesia. The difference in mean was analyzed using post hoc Bonferroni test and ANOVA test. The difference in proportions was analyzed by using chi-square test. Results: SBP, DBP and MBP were statistically lower in both Granisetron and Saline group as compared to Ondansetron group at most of the times after drug administration. Heart rate and shivering were comparable in the three groups. Nausea and vomiting was statistically more in saline group as compared to other groups. Use of ephedrine was also significantly more in saline group (37%). Conclusion: 4mg intravenous Ondansetron prior to spinal anaesthesia in LSCS patients reduces the incidence of hypotension, bradycardia and need of vasopressor. Granisetron had no effect on haemodynamic parameters.

The efficacy and safety of granisetron with ondansetron for the prevention of post-operative nausea and vomiting in patients undergoing cesarean section under spinal anesthesia

“…Considering the shorter overall duration of follow-up in the present study, the duration of blocked follow-up periods was also narrow, but within this narrow blocking of post-operative periods, we found that the performance of granisetron was better than that of ondansetron, which was also observed in previous studies that used the same drug-dose combinations but whose studies used different post-operative time blocks. 19,20 In the present study, the need for emergency antiemetics was higher in the ondansetron group (9.3%) than in the granisetron group. Side effects such as headache and dizziness were also more common in the ondansetron group (18.6% and 14%) than in the granisetron group (7% and 0%), although the difference was only statistically significant for dizziness.…”

“…In their study, Anisha and Narayan 20 found side effects such as tremors, pain, nausea, and bradycardia in 0%-10% of patients in the ondansetron group and 10%-17% of patients in the granisetron group, although these were not statistically significant. In their study, Makker et al, 16 and Mehta et al, 19 reported headache and dizziness in 6.7%-10% in the ondansetron group and 6.7% and 6.7% in the granisetron group, respectively, and found no significant difference between the two groups.…”

Granisetron versus Ondansetron: Comparison of 5HT3 antagonists in preventing spinal anaesthesia induced hemodynamic instability in obstetric patients

“…Approval was taken from the Ethics Review Committee at Army Medical College, National University of Medical Sciences (ERC/ID/123, on 7 th September, 2021), and at CMH (Serial Number: 175/6/21, on 3 rd September 2021). A sample size of 41 was calculated using reported incidence of hypotension 11 , via the World Health Organization (WHO) sample size calculator. However, a sample size of 120 was kept to improve the power of the study, with 40 participants in each group.…”

The Potential of Granisetron in Preventing Spinal Anesthesia Induced Hypotension on Non-Obstetric Procedure

“…The decrease in preload will stimulate the mechanoreceptor and chemoreceptor on the left ventricle wall, which is serotonin sensitive. [5, 10,11] Serotonin released by platelets, enterochromaffin cells, and the nervous system will bind to its receptor, specifically 5-HT3 type then activate the Bezold Jarisch Reflex (BJR). BJR is a cardioinhibitory mechanism with triad hypotension, bradycardia, and apnea.…”