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. 2024 Jul 22;16(7):e65073.
doi: 10.7759/cureus.65073. eCollection 2024 Jul.

Effect of Ondansetron on Maternal Hypotension During Spinal Anesthesia With Ropivacaine for Cesarean Sections: A Randomized, Double-Blind Trial

Stavroula Karachanidi  1 , Anteia Paraskeva  1 , Polyxeni Theodosopoulou  1 , Georgia Micha  2 , Chryssoula Staikou  1
Affiliations

Effect of Ondansetron on Maternal Hypotension During Spinal Anesthesia With Ropivacaine for Cesarean Sections: A Randomized, Double-Blind Trial

Stavroula Karachanidi et al. Cureus. .

Abstract

Introduction: Ondansetron, a selective 5-hydroxytryptamine 3 (5-HT3) receptor antagonist, has been proven to be effective in the prevention of spinal-induced hypotension for elective cesarean section.

Methods: A total of 138 primigravida parturients scheduled for elective cesarean section were randomly assigned to three groups. Groups ONDA4 and ONDA8, respectively, received 4 and 8 mg of ondansetron in 100 mL normal saline, before spinal anesthesia with 1.7 mL ropivacaine 0.75% and 15 mcg of fentanyl, whereas the CONTROL group received an equal volume of normal saline. Noninvasive blood pressure and heart rate were recorded upon arrival, before and after spinal injection, and thereafter every minute for a time period of 10 minutes along with total doses of phenylephrine (mcg) or ephedrine (mg). Time required for the spinal anesthesia to achieve a sensory and motor block at the T4 level and Bromage 3 scale respectively, as well as to regress to the T7 level and a Bromage 1 scale were noted. Maternal nausea/vomiting or shivering, umbilical artery pH, and neonatal Apgar score at 1 and 5 min were also recorded.

Results: There were no differences between groups in systolic, diastolic blood pressure, heart rate (p=0.355, p=0.550, p=0.474 respectively), doses of phenylephrine or ephedrine, (p=0.920, p=0.142 respectively), time for the block to reach T4 (p=0.889) and Bromage scale 3 (p=0.269), or to regress to T7 (p=0.273) and Bromage scale 1 (p=0.392), the incidence of nausea/vomiting (p=0.898/p=0.365), umbilical artery pH (p=0.739), neonatal Apgar score at 1 and 5 min (p=0.936 and p=0.907 respectively).

Conclusion: Our results showed no significant effect of two different doses of ondansetron, in preventing maternal hypotension, following spinal anesthesia with ropivacaine for cesarean section.

Keywords: cesarean section (cs); hypotension; isobaric ropivacaine; obstetric anesthesia; spinal.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Ethics Committee of Aretaieion University Hospital issued approval 124/17-04-2019. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Flow diagram
ONDA4: group ONDA4 received 4 mg ondansetron; ONDA8: group ONDA8 received 8 mg ondansetron; SAP: systolic arterial pressure
Figure 2
Figure 2. Systolic arterial pressure (SAP) and diastolic arterial pressure (DAP) were measured at selected time points: upon arrival in the operating room (1), one minute before spinal anesthesia (2), immediately after spinal injection (3), and at one-minute intervals up to 10 minutes (F=1.044 and P=0.355, F=0.6 and P=0.550)
ONDA4: group received 4 mg ondansetron; ONDA8: group received 8 mg ondansetron
Figure 3
Figure 3. Heart rate (HR) was measured at selected time points: upon arrival in the operating room (1), one minute before spinal anesthesia (2), immediately after spinal injection (3), and at one-minute intervals up to 10 minutes (F=0.75 and P=0.474).
ONDA4: group received 4 mg ondansetron; ONDA8: group received 8 mg ondansetron
See this image and copyright information in PMC

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