Efficacy and safety of ondansetron in preventing postanesthesia shivering: a meta-analysis of randomized controlled trials

Abstract

BackgroundShivering is a very common complication in the postanesthesia period. Increasing studies have reported ondansetron may be effective in prevention of postanesthesia shivering (PAS). However, the results remained controversial; hence we conducted a meta-analysis of randomized controlled trials to evaluate the efficacy and safety of ondansetron on the prevention of postanesthesia shivering.MethodsPubMed and Embase databases were searched to identify the eligible randomized controlled trials assessing the effect of ondansetron on the prevention of PAS. Results were expressed as risk ratios (RRs) with accompanying 95% confidence intervals (CIs). The meta-analysis was performed with fixed-effect model or random-effect model according to the heterogeneity.ResultsSix trials including 533 subjects were included. Compared with placebo, ondansetron was associated with a significant reduction of PAS (RR 0.43, 95% CI, 0.27-0.70), without an increased risk of bradycardia (RR 0.37, 95% CI, 0.12-1.15). Compared with meperidine, no difference was observed in the incidence of PAS (RR 0.68, 95% CI, 0.39-1.19) and bradycardia (RR 2.0, 95% CI, 0.38-10.64).ConclusionsOndansetron has a preventive effect on PAS without a paralleled side effect of bradycardia.

Ramosetron vs Ramosetron with Dexmedetomidine for Prevention of Postoperative Nausea Vomiting and Shivering after Gynaecological Laparoscopic Surgery: A Comparative Study

“…Both heat loss and heat production pathways are influenced, thus changing the thermoregulatory set points without affecting the core or peripheral temperature 21,22 .…”

Preventative effect of ondansetron on postanesthesia shivering in children undergoing caudal anesthesia: a randomized double-blinded clinical trial

“…Meperidine decreases shivering but can cause nausea, vomiting, and respiratory depression (7). And of the other antishivering drugs, clonidine can cause bradycardia, hypotension, and sedation; tramadol can cause nausea, vomiting; and dizziness; and physostigmine can cause nausea, vomiting, increased heart rate, and increased blood pressure (1,7).…”

“…Ondansetron, a specific antagonist of the 5-HT 3 receptor for serotonin and a drug currently used to inhibit postoperative nausea and vomiting, decreases the incidence of postanesthesia shivering after both general and regional anesthesia and has few side effects (3)(4)(5)(7)(8)(9). However, all studies of its effectiveness have been performed on adults.…”

“…Central control of the thermoregulatory center is complex and involves a number of neurotransmitters and receptors (2). Agents acting on several pathways, for example, the α-2 adrenergic agonist clonidine, the opioid meperidine, and the anticholinergic agent physostigmine, have been shown to decrease postanesthetic shivering (4-6).Ondansetron, a specific antagonist of the 5-HT 3 receptor for serotonin and a drug currently used to inhibit postoperative nausea and vomiting, decreases the incidence of postanesthesia shivering after both general and regional anesthesia and has few side effects (3)(4)(5)(7)(8)(9). However, all studies of its effectiveness have been performed on adults.…”

Efficiency and safety of ondansetron in preventing postanaesthesia shivering

“…A previous meta-analysis concluded it reduces the incidence of PAS without showing an increased risk of bradycardia. 19 However, some new randomised controlled trials (RCTs) have since been published on this topic. Our meta-analysis therefore sought to determine the effectiveness and safety of ondansetron by comparing it with placebo and pethidine in terms of the preventative effect on PAS and also adverse effects.…”