Prophylactic Ondansetron Does Not Prevent Shivering or Decrease Shivering Severity During Cesarean Delivery Under Combined Spinal Epidural Anesthesia

Abstract

Intravenous ondansetron 8 mg before performing CSE anesthesia in women undergoing elective cesarean delivery does not decrease the incidence or severity of shivering.

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

“…The dosage of ondansetron was either 4 mg or 8 mg in individual study, and meperidine was 0.4 mg/kg in all the three studies [13,15,18]. The trial drugs were all given before anesthesia, but one [17] at the end of the surgery.…”

“…Study by Browning et al [17], which found ondansetron could not reduce the incidence of shivering, contributed to the heterogeneity as identified by forest plots and sensitive analysis. The subgroup analysis also confirmed the source of the heterogeneity was from the study (data not show).…”

“…Firstly, the test power, to some extent, is limited as confined by the sample size. The individual study in this meta-analysis has a relatively small sample with only one study [17] more than 100 subjects. Secondly, the definitions of PAS vary from each other.…”

“…Consistently, several studies [3,13-16] have demonstrated ondansetron can prevent PAS, which made ondansetron a promising drug for postoperative complications including PAS, nausea and vomiting. However, a later-day, large-sample study conducted by Browning et al [17] presented that ondansetron did not prevent PAS among women undergoing combined spinal and epidural anesthesia for cesarean delivery. To our knowledge, there is no meta-analysis to identify the precise effect of ondansetron on the PAS, therefore, we performed a systematic review and meta-analysis of randomized controlled trials to evaluate and quantify the preventive effect of ondansetron on PAS.…”

Comparison of Ondansetron and Meperidine for Treatment of Postoperative Shivering: A Randomized Controlled Clinical Trial

“…These studies indicate the role of serotonin receptors in thermoregulation at different levels. Nevertheless, some studies have reported that ondansetron did not change the threshold of shivering and probably reduces shivering thorough the central effects and ondansetron does not decrease the incidence or severity of shivering in women undergoing elective cesarean delivery (17, 18). Although 0.4 mg/kg of meperidine rarely causes unwanted cardiovascular effects, it may cause respiratory depression, particularly when used with other opioids.…”