A meta-analysis of randomized controlled trials: efficiency and safety of ondansetron in preventing post-anesthesia shivering during cesarean section

• Published in: Archives of gynecology and obstetrics Vol. 307; no. 1; pp. 223 - 231
• Main Authors: Zheng, Guanghao, Zhang, Jieyu, Liu, Jianpin, Chen, Chunxiang, Zhang, Li, Cao, Fei
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-01-2023; Springer Nature B.V
• Subjects: Anesthesia; Anesthesia, Spinal - adverse effects; Anesthesia, Spinal - methods; Cesarean section; Cesarean Section - adverse effects; Clinical trials; Double-Blind Method; Efficiency; Endocrinology; Female; Gynecology; Human Genetics; Humans; Hypotension; Maternal-Fetal Medicine; Medicine; Medicine & Public Health; Meta-analysis; Obstetrics/Perinatology/Midwifery; Ondansetron - adverse effects; Pregnancy; Randomized Controlled Trials as Topic; Shivering; Shivering; Ondansetron; Cesarean section; Meta-analysis
• ISSN: 1432-0711; 0932-0067; 1432-0711
• DOI: 10.1007/s00404-022-06523-2

Objective
Although ondansetron was considered to prevent post-anesthesia shivering during cesarean section, its efficiency remained controversial. Our review was conducted to estimate the efficiency and safety of ondansetron in preventing post-anesthesia shivering during cesarean section.
Methods
The literature were searched from their inception to October 2020 without restriction of language. All randomized controlled trials investigating the efficacy of ondansetron versus placebo in preventing shivering during cesarean section under neuraxial anesthesia were included. The meta-analysis was conducted using Stata software.
Results
Eleven randomized controlled studies with a total of 748 individuals were finally included in our meta-analysis. Our results manifested that intravenous ondansetron compared with intravenous placebo significantly reduced the incidence of post-anesthesia shivering (PAS) (RR 0.53, 95% CI 0.14–0.68). Subgroup analysis according to doses of ondansetron indicated that the efficacy of 4 mg doses of ondansetron (RR 0.37, 95% CI 0.21–0.64) is equivalent to that of 8 mg doses of ondansetron (RR 0.61, 95% CI 0.47–0.81) in preventing PAS. In addition, the intravenous ondansetron led to a lower incidence of hypotension than intravenous placebo (OR 0.47, 95% CI 0.32–0.70). We could not demonstrate differences in the incidence of bradycardia between intravenous ondansetron and intravenous placebo.
Conclusion
Our results found that intravenous ondansetron was effective in preventing shivering during cesarean section under neuraxial anesthesia, and had an advantage in reducing the incidence of hypotension compared with intravenous placebo.