Abstract:Ondansetron premedication does not attenuate hemodynamic changes after subarachnoid anesthesia nor does it reduce the amount of vasopressor use, pruritus, or nausea and vomiting.
“…Initially, 728 related articles were detected, with 21 RCTs finally enrolled after step-by-step screening. 6 – 26 The literature screening process and results are shown in Figure 1 . Figure 1.…”
ObjectiveTo investigate the efficacy and safety of ondansetron during cesarean section under spinal anesthesia.MethodsWe sought randomized controlled trials (RCTs) on ondansetron during spinal anesthesia for cesarean section in The Cochrane Library, PubMed, MEDLINE, and Web of Science from their inception to September 2016.ResultsAltogether, 21 RCTs were included in this study. Meta-analysis showed that the ondansetron group had a lower incidence of nausea/vomiting and bradycardia than the placebo group during cesarean section under spinal anesthesia [relative risk (RR) = 0.43, 95% confidence interval (CI) (0.36, 0.51) and RR = 0.45, 95% CI (0.26, 0.80), respectively]. There were no significant differences in the incidences of pruritus, hypotension, or shivering during cesarean section under spinal anesthesia [RR = 0.92, 95% CI (0.83, 1.02); RR = 0.72 (0.50, 1.06), 95% CI (0.50, 1.06); and RR = 0.89, 95% CI (0.71, 1.11), respectively].ConclusionOndansetron effectively reduces the incidences of nausea/vomiting and bradycardia under spinal anesthesia during cesarean section.
“…Initially, 728 related articles were detected, with 21 RCTs finally enrolled after step-by-step screening. 6 – 26 The literature screening process and results are shown in Figure 1 . Figure 1.…”
ObjectiveTo investigate the efficacy and safety of ondansetron during cesarean section under spinal anesthesia.MethodsWe sought randomized controlled trials (RCTs) on ondansetron during spinal anesthesia for cesarean section in The Cochrane Library, PubMed, MEDLINE, and Web of Science from their inception to September 2016.ResultsAltogether, 21 RCTs were included in this study. Meta-analysis showed that the ondansetron group had a lower incidence of nausea/vomiting and bradycardia than the placebo group during cesarean section under spinal anesthesia [relative risk (RR) = 0.43, 95% confidence interval (CI) (0.36, 0.51) and RR = 0.45, 95% CI (0.26, 0.80), respectively]. There were no significant differences in the incidences of pruritus, hypotension, or shivering during cesarean section under spinal anesthesia [RR = 0.92, 95% CI (0.83, 1.02); RR = 0.72 (0.50, 1.06), 95% CI (0.50, 1.06); and RR = 0.89, 95% CI (0.71, 1.11), respectively].ConclusionOndansetron effectively reduces the incidences of nausea/vomiting and bradycardia under spinal anesthesia during cesarean section.
“…14 The study was approved by the University of Virginia institutional review board (IRB –HSR # 14583), and was registered at clinicaltrials.gov (NCT 01414777). In this study, we tested the hypothesis that ondansetron may prevent acute opioid induced tolerance to intrathecal opioids in patients undergoing cesarean delivery under spinal anesthesia.…”
Section: Methodsmentioning
confidence: 99%
“…Analgesic requirements were converted to morphine equivalents based on a validated conversion chart. 14 We followed our institutional post-cesarean delivery analgesia protocol. Patients were given fixed acetaminophen 650 mg every 8 hours alternating with naproxen sodium 500 mg every 12 hours for the first 24 with on-demand analgesia of opioids medications throughout the hospital stay.…”
Background
Multiple animal studies suggest that ondansetron ameliorates opioid-induced hyperalgesia and tolerance. In this study, we aimed to determine if the administration of ondansetron prior to spinal anesthesia would have an effect on intrathecal opioid-induced acute opioid tolerance, postoperative pain, and analgesic requirements in patients undergoing cesarean delivery with spinal anesthesia.
Methods
Eighty-six patients undergoing elective cesarean delivery were recruited and randomly allocated to receive either 8 mg intravenous ondansetron (n=44) or placebo (n=42) in a prospective, double-blind design. All patients received spinal anesthesia consisting of 15 mg bupivacaine, 20 μg of fentanyl, and 100 μg of preservative-free morphine. We used linear mixed-effects models to assess the difference in pain and opioid consumption in the first 24 hours after surgery between the 2 groups.
Results
No differences between the 2 groups were found in age, BMI, ASA scores, duration of surgery, or sensory and motor block characteristics. There was no difference between the 2 groups in postoperative pain scores (P = 0.95) or opioid consumption (P = 0.68)
Conclusions
In patients undergoing cesarean section under spinal anesthesia with intrathecal opioids, the administration of ondansetron prior to spinal anesthesia did not significantly affect postoperative pain scores or opioid consumption. Thus, the administration of ondansetron did not have an effect on acute opioid tolerance in our study.
“…A total of 10 potential confounding variables were extracted and used for the propensity score-matching between the two groups. These confounding factors included age, gravida, para, number of fetuses, gestational age, body mass index [BMI], number of previous cesarean deliveries, infant weight, surgery time, amount of oxytocin used, whether additional uterotonic (methergine and hemabate) were used, amount of bupivacaine [16] and ondansetron [17] used, admission hematocrit, and admission platelet counts.…”
Background
Hydroxyethyl starch is commonly used in the obstetric patient population to prevent hypotension during cesarean delivery. Evidence suggests hetastarch is associated with a dysfunction in coagulation cascade. We hypothesized that hetastarch use to prevent spinal hypotension during cesarean delivery would be associated with an increase in blood loss when compared to crystalloid use.
Methods
We performed a retrospective review of patients who underwent elective cesarean delivery under spinal anesthesia at the University of Virginia between 2011 and 2014. Data from 819 patients was used. Blood loss was the primary outcome. Propensity score-matching was used to match patients who received hetastarch (treatment group) with those who did not receive hetastarch (control group).
Results
Genetic matching resulted in 196 patients in the hetastarch group and 182 patients in the control group. There was no difference in estimated blood loss (p = 0.068), calculated blood loss (p = 0.720), total intra-operative fluid intake (p = 0.289), urine output (p = 0.421), Apgar 1 min (p = 0.830), Apgar 5 min (p = 0.138), phenylephrine consumption (p = 0.742), postoperative day 1 (POD1) hematocrit (p = 0.070) and POD1 platelets (p = 0.233). However, there was a statistically significant difference (but clinically irrelevant) in hematocrit difference between the day of admission and POD1 (mean difference 0.47, p = 0.024), and ephedrine consumption (mean difference 2 mg, p = 0.017) in favor of the control group.
Conclusions
Our study did not find an association between increased perioperative blood loss and hetastarch use in patients presenting for elective cesarean delivery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
