Key result
Prophylactic intravenous ondansetron significantly reduced the incidence of spinal-induced hypotension by an absolute 36.9% compared to placebo in parturients undergoing elective cesarean section.
Why the study?
Spinal anesthesia is widely used for caesarean sections, but its efficacy in reducing spinal-induced hypotension using intravenous ondansetron needed evaluation.
Does intravenous ondansetron reduce spinal-induced hypotension in parturients undergoing elective cesarean delivery under spinal anesthesia?
RCT (n=92)
Double-blind
Computer-generated random numbers and sealed envelope technique
No
Does intravenous ondansetron reduce spinal-induced hypotension in parturients undergoing elective cesarean delivery under spinal anesthesia?
Absolute Risk Reduction: 36.9
Absolute Event Rate: 26.1% vs 63%
Absolute Risk Reduction: 36.9%
p-value: p=<0.001
Prophylactic intravenous ondansetron significantly reduces the incidence of spinal-induced hypotension and the need for vasopressors in parturients undergoing elective cesarean section.
Supports prophylactic ondansetron in elective cesarean spinal anesthesia; confirms prior RCT efficacy on hypotension reduction.
BackgroundSpinal anesthesia is the predominant technique utilized for caesarean sections, owing to its quick onset, straightforward administration, and efficacy. Objective: The aim is to evaluate how well intravenous ondansetron reduces spinal-induced hypotension in parturients who underwent elective cesarean delivery under spinal anaesthesia. MethodsPatna Medical College & Hospital conducted this prospective, randomized, double-blind trial over a 12-month period. Randomized into two groups (n=46 each), ninety-two ASA I/II parturients booked for elective lower segment cesarean delivery under spinal anesthesia were: Group O (ondansetron group): Five minutes before spinal anesthesia, 8 mg of ondansetron intravenously. Group C (Control group) received 10 mL of normal saline intravenuously. Using 2 mL of 0.5% hyperbaric bupivacaine, all patients underwent spinal anesthesia. Baseline and consistent interval documentation of hemodynamic measurements—systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR)—was recorded for thirty minutes following the block. There were reports of hypotension, vasopressors (ephedrine), and side effects included nausea and vomiting. ResultsThe occurrence of hypotension was markedly reduced in Group O (26.1%) in contrast to Group C (63%). The ondansetron group required a much lower overall dose of ephedrine. Moreover, Group O saw a reduced incidence of intraoperative nausea and vomiting. The hemodynamic parameters exhibited greater stability in the ondansetron group during the monitoring period. No negative effects were observed in either group. ConclusionThe prophylactic injection of intravenous ondansetron markedly diminishes the occurrence and intensity of spinal-induced hypotension in parturients having cesarean section. Its use also diminishes the necessity for vasopressors and enhances intraoperative mother comfort by alleviating nausea and vomiting. Ondansetron, a secure and easily accessible medication, may be regarded as a beneficial addition in the therapy of spontaneous intracranial hypotension during obstetric anesthesia.
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Neeraj et al. (2024) conducted an RCT in Spinal-induced hypotension during cesarean section (n=92). Ondansetron vs. 10 mL of normal saline intravenously (Placebo) was evaluated on Incidence of spinal-induced hypotension (ARR 36.9%, p=<0.001). Prophylactic intravenous ondansetron significantly reduced the incidence of spinal-induced hypotension by an absolute 36.9% compared to placebo in parturients undergoing elective cesarean section.
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