Utilization of Ondansetron Prior to Spinal Block to Attenuate Spinal-Induced Adverse Effects during Cesarean Section

Abstract

Background: Hypotension and bradycardia occur at high rates during cesarean section under spinal anesthesia (SA). Recently, ondansetron has proven to attenuate these side effects during SA for cesarean section and is a promising adjunct to traditional techniques. Further exploration is needed to discover ondansetron’s effects solely in obstetrics and to create recommendations on its use.

Objectives: The systematic review aimed to assess the best present randomized controlled trials (RCTs) regarding the efficacy of ondansetron given before SA for cesarean section and to introduce recommendations for anesthesia professionals to utilize to lessen spinal-induced hypotension, bradycardia, and excess vasopressor use (VU).

Data Sources: Investigators used CINAHL, MedLine, and EMBASE databases to answer the PICO (i.e., population, intervention, comparison, outcome) question: In ASA 1 and 2 obstetric cesarean section patients, does the use of ondansetron five minutes prior to spinal block compared to no ondansetron reduce spinal-induced hypotension, bradycardia, and vasopressor use?

Study Selection: Seven RCTs were included in this systematic review and incorporated into the recommendations. Inclusion criteria included: RCTs in English, published 2007-present, parturients under SA for cesarean section, ondansetron given before spinal, outcomes including hypotension, bradycardia, and VU.

Results: The 7 RCTs had a combined sample size of 642 parturients. Five RCTs found 4 mg of ondansetron 5 minutes prior to SA for elective cesarean section to significantly attenuate hypotension and excess VU. Two RCTs found a significant change in heart rate.

Conclusions: The empirical evidence shows the administration of ondansetron 4 mg 5 minutes before SA as an adjunct to traditional treatment has shown to attenuate hypotension and excessive VU. The implementation of an evidence-based algorithm utilizing ondansetron leads to positive patient outcomes and potential increased patient satisfaction.