The role of ondansetron in prevention of post-spinal shivering (PSS) in obstetric patients: A double-blind randomized controlled trial

Background: Elective cesarean delivery (C/D) under neuraxial anesthesia is commonly associated with shivering. Ondansetron is a widely used antiemetic during both pregnancy and surgery. Few controversial studies investigated its anti-shivering effect in C/D under spinal anesthesia. Objectives: To study the efficacy of ondansetron to prevent post-spinal shivering in parturients underwent cesarean delivery under spinal Anesthesia. Methods: This double-blinded, prospective, randomized, trial included 80 parturients underwent C/D under spinal anesthesia, randomized into two equal groups [40 patients each]; group O [Ondansetron]: received 8 mg/4 ml ondansetron and group S [Saline] received 4 ml normal saline as placebo. Post-spinal shivering and maximum shivering at any time were recorded on a (0–4) scale and total meperidine dose required to treat shivering at score ⩾ 3, was calculated. Maternal MAP assessed before spinal anesthesia (T0), just after spinal and lateral tilt positioning (T1), 2 min after positioning (T2), 5 min after positioning (T3), Just after delivery of the baby (T4), at the end of surgery (T5), together with total ephedrine (required to treat any hypotension) were recorded. Incidence of nausea and vomiting at any time during surgery was also recorded. Results: Incidence of shivering, maximum shivering, total meperidine dose and incidence of nausea were lower in ondansetron group compared to saline group. Maternal MAP was lower at (T3) in placebo group, without difference in the total ephedrine dose between the two study groups. Conclusion: Ondansetron (8 mg) was effective in reducing post-spinal shivering in parturients underwent elective cesarean delivery and decreasing the requirement to meperidine together with lower incidence of post-spinal hypotension and nausea when compared to placebo (saline)