Details
Category: Volume 10 Issue 01 January 2022
Hits: 607

Title: Randomized double blind comparative study of the efficacy of ondansetron and palonosetron in prevention of postoperative shivering in patients undergoing elective LSCS under spinal anaesthesia

Authors: Dr Rumani Ruku, Dr Nikita Gandotra

 DOI: https://dx.doi.org/10.18535/jmscr/v10i1.19

Abstract

Background: Post anesthesia shivering (PAS) is a common, distressing experience. Ondansetron, the classical 5-HT3 antagonist has been in use for its prevention since long. Palonosetron, a newly introduced potent antiemetic drug with better pharmacodynamics. A study was conducted to compare the efficacy of ondansetron and palonosetron in preventing PAS in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia. Different observations suggest that the serotonergic system has a role in the control of postanesthetic shivering. Therefore, the sudy compared the effect of ondansetron and palonosetron in preventing PAS in patients undergoing elective lower segment caesarean section (LSCS) under spinal anaesthesia.

Methods: A double blind randomized prospective study was conducted in the Department of Anesthesia, GMC Jammu. A total of 64 patients scheduled for elective LSCS under spinal anesthesia were randomly allocated to one of the two study groups. Accordingly, 8 mg of ondansetron or 0.075 mg palonosetron was administered in the same volume intravenously 30 min preoperatively.

Results: No statistically significant intergroup difference was observed in the duration of surgery, and nasopharyngeal temperature. However, statistically significant difference was recorded for PAS, with 28.12% patients (9/32 patients) experienced shivering in Group I at 30-Minute interval, which was significantly lower in Group II (18.75%; 6 out of 32 patients) and p-value was 0.012. The difference was significant at 60-Minutes interval (p = 0.044) also.

Conclusion: When used prophylactically, palonosetron significantly reduced incidence of PAS compared to ondansetron. However, further studies with larger sample size and more heterogeneous groups are suggested.

Keywords: Spinal anesthesia, Lower Segment Caesarean Section, Ondansetron, palonosetron, post-anesthesia shivering, Core Temperature.

References

  1. Buggy DJ, AWA Crossley: thermoregulation, mild preoperative hypothermia & post-anesthetic shivering BJA 2000; 84 (5) 615-28.
  2. Sessler DI. Periancsthetic thermoregulation and heat balance in humans. FASEB J 1993; 7: 638-44.
  3. Crossley AWA: Peri –operative shivering. Anesthesia 1992; 47: 193-5].
  4. De Witte J, Sessler DI. Perioperative shivering: Physiology and pharmacology. Anaesthesiology 2002;96:467‑
  5. Kamal MM, Hussein NS. Prevention of post spinal shivering by using ketamine plus Midazolam in comparison with Neopam. Egypt Anaesth 2011;27:1‑
  6. Horn E.P.C. Werner, D.I. Sessler, M. Stein fath and J. Schulte am Esch: Late interaoperative clonidine administration prevents PAS after total i/v or Volatile anesthesia. Anaesth analg. 84 (1997), 613-17.
  7. Wrench IJ, Singh P, Dennis AR, Mahajan RP, Crossley AW. The minimum effective doses of pethedine and doxapram in the treatment of post anaesthetic shivering.Anaesthesia1977;52:32‑
  8. Kranke P, Eberhart LH, Roewer N, Tamer MR. Pharmacological treatment of postoperative shivering: A quantitative systematic review of randomized controlled trials. Anesth Analg 2002;94:453‑
  9. Eberhart LH, Doderlein F, Eisenhardt G, Kranke P, Sessler DI, Torossian A, et al. Independent risk factors for postoperative shivering.Anesth Analg 2005;101:1849‑
  10. Jo YY, Kwak HJ, Lee MG, Lim OK. Effect of palonosetron on postanesthetic shivering after propofol‑remifentanil total intravenous anesthesia. J Anesth 2013;27:533‑
  11. Robert M. Powell, Donal J. Buggy: Ondansetron given before induction of anesthesia reduces shivering after general anesthesia. Anaesth Analg 2000; 90: 1423-7.
  12. Kelsaka E, baris s, Karakaya D, Sarihasan B: Comparison of ondansetron and meperidine for prevention of shivering in patients undergoing spinal anesthesia. Reg Anesth Pain Med. 2006 Jan-Feb; 31(1): 40-5.
  13. Shash E, AbdullaM. Palonosetron: An overview. Adv Oncol 2010;8:18‑
  14. Jo YY, Kim YB, Lee D, Chang YJ, Kwak HJ. Implications of palonosetron in elderly patients undergoing laparoscopic cholecystectomy with respect to its anti‑shivering effect. Aging Clin Exp Res 2016;28:83‑
  15. Zhou C, Zhu Y, Liu Z, Ruan L. 5‑HT3 receptor antagonists for the prevention of postoperative shivering: A meta‑ JIntMedRes 2016;44: 1174‑81.
  16. Lakhe G, Adhikari KM, Khatri K, Maharjan A, Bajracharya A, Khanal H. Prevention of shivering during spinal anaesthesia: Comparison between tramadol, ketamine and ondansetron. JNMA J Nepal Med Assoc. 2017;56:395‑
  17. Badawy AA, Mokhtar AM. The role of ondansetron in prevention of post‑spinal shivering (PSS) in obstetric patients: A double‑blind randomized controlled trial. Egypt J Anaesth 2017;33:29‑

Corresponding Author

Dr Rumani Ruku

Department of Anaesthesiology and Intensive Care