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

Salahat, Ahmad M; Taha, Adham Abu; Almasri, Nouraldin; Sweity, Essa; Saed, H; Zyoud, .

doi:10.26502/ogr093

Cited by 2 publications

(13 citation statements)

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“…Further exclusion of studies following title/abstract review left a total of 93 full-text articles to be retrieved, of these 23 met the inclusion criteria. 38–60 The full search and details for study exclusion are displayed as a PRISMA flow diagram (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 15 studies used intrathecal morphine, 38,39,42,45–47,49,50,53,55–62 of which 5 were used in combination with fentanyl 42,47,53,55,57 and 1 with sufentanil. 59 Intrathecal morphine dose ranged between 0.1 and 0.2 mg.…”

Section: Resultsmentioning

confidence: 99%

“…Follow-up period for pruritus was ≥24 hours in 14 studies, 38–40,42,44–47,51,55,56,58–60 30 minutes/end of surgery in 4 studies, 41,48,51,52 and 4 hours/leaving postanesthetic care unit (PACU) in 5 studies. 43,49,53,54,57…”

Section: Resultsmentioning

confidence: 99%

“…A fixed dose of 4 mg ondansetron was used in 9 studies, 41–43,45,46,49,53,54,58 a fixed dose of 8 mg ondansetron was used in 9 studies, 40,44,47,48,52,55–57,60 and 3 studies compared both 4 mg and 8 mg groups individually. 38,39,51 An additional 2 studies used variable dosing 0.1 mg/kg (mean dose, 7.0 mg and 7.1 mg, respectively), 50,60 with one of these also using a lower variable dose of 0.05 mg/kg (mean dose, 3.4 mg).…”

Section: Resultsmentioning

confidence: 99%

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Ondansetron for the Prevention of Pruritus in Women Undergoing Cesarean Delivery With Intrathecal Opioid: A Systematic Review and Meta-Analysis

Cadd,

Jackson,

Ewnetu

2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Pruritus is a frequently reported and unpleasant side effect following intrathecal opioid use with frequency further increased among parturients. We have performed a systematic review to assess the overall efficacy of ondansetron for the prevention of pruritus in patients receiving intrathecal opioid as part of spinal anesthesia for cesarean delivery. METHODS: A literature search of MEDLINE, Embase, Cochrane, and Web of Science databases was conducted from date of inception to September 2022. Studies that included patients undergoing cesarean delivery with spinal anesthesia using intrathecal opioid were included. The primary outcome was the presence of pruritus, and the secondary outcome was time to onset of pruritus. Data from included studies were pooled for analysis using an appropriately determined random-effects model. Outcomes were presented using forest plots and 95% confidence intervals. Additional sensitivity and subgroup analysis were performed. Trial sequential analysis was conducted for the primary outcome. RESULTS: Twenty-three randomized controlled trials with a total of 2586 patients were included: 1219 received ondansetron, 1030 received a placebo, and a further 337 received a different study drug and were excluded from analysis. Opioids used in the included studies were morphine, fentanyl, and sufentanil. Patients who received ondansetron showed a significant reduction in the incidence of pruritus compared to the control group (RR, 0.81; 95% confidence interval [CI], 0.71–0.92; I2 = 64%). There was no significant difference in pruritus onset between the groups (mean difference [MD], 17.54 minutes; 95% CI, −2.18 to 37.26; I2 = 83%). The overall Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment of quality of evidence was low. CONCLUSIONS: This systematic review has demonstrated a significant reduction in the incidence of pruritus following the use of ondansetron. This is in contrast to previously published meta-analyses. Studies included were of varying quality and some at high risk of bias with a high degree of statistical heterogeneity. Furthermore, high-quality and well-powered studies are required to confirm these findings.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Ondansetron for the Prevention of Pruritus in Women Undergoing Cesarean Delivery With Intrathecal Opioid: A Systematic Review and Meta-Analysis

Cadd,

Jackson,

Ewnetu

2023

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

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“…The intensity of shivering during the operation was monitored at five-minute intervals for one hour. Shivering was evaluated using the following scale: 0 indicated that there was no shivering, 1 stated that there was piloerection or peripheral vasoconstriction but no visible shivering, 2 indicated that there was muscular activity in only one muscle group, 3 stated that there was muscular activity in more than one muscle group but that it was not generalized, and 4 indicated that there was shivering that involved the entire body (Salahat, 2020). Hallucinations, nausea, vomiting, nystagmus, and sweating were some of the adverse effects of the medications that were used in the study.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Ketamine and Tramadol for Prevention of Shivering During Spinal Anesthesia

AVAIS

JAVED

SHEIKH

et al. 2022

Biol Clin Sci Res J

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After receiving a spinal anesthetic, shivering is a common side effect. This research aimed to compare the effectiveness of Ketamine and Tramadol in reducing the occurrence of shivering. One hundred and fifty patients aged 18 to 60 with ASA physical status I or II having different surgical procedures were randomly assigned to receive either Intravenous (IV) normal saline (Group P), IV 0.5mg/kg ketamine (Group K), or IV 0.5kg/mg tramadol (Group T).The frequency of shivering, its impact, and the onset of nausea, vomiting, sweating, and nystagmus were all noted. Patients were similar in demographics, body temperature at baseline, operation type, median sensory blockage, surgery duration, and anesthetic. 23.3% of patients (35/150) experienced shivering episodes.Twenty-twopatientsin the placebo group, followed by eight in treatment Group T, and five in treatment group K, reported shivering. The study revealed a statistically significant difference (p = 0.006) between Group K and P. When comparing Group T to Group K (p = 0.871) and Group P (p = 0.724), however, no group showed statistical significance. In group K, nystagmus was one of the most commonly reported adverse effects of IV ketamine, affecting 35 patients (70%). Therefore, compared to the placebo group, Ketamine at a dose of 0.5mg/kg reduces the shivering associated with spinal anesthesia. But there was no statistically significant difference between Ketamine and the intravenous 0.5 mg/kg Tramadolgroup found in our study.

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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

Cited by 2 publications

References 0 publications

Ondansetron for the Prevention of Pruritus in Women Undergoing Cesarean Delivery With Intrathecal Opioid: A Systematic Review and Meta-Analysis

Ondansetron for the Prevention of Pruritus in Women Undergoing Cesarean Delivery With Intrathecal Opioid: A Systematic Review and Meta-Analysis

Comparison of Ketamine and Tramadol for Prevention of Shivering During Spinal Anesthesia

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