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Prophylactic Ondansetron Does Not Prevent Shivering or Decrease Shivering Severity During Cesarean Delivery Under Combined Spinal Epidural Anesthesia: A Randomized Trial
  1. Roger M. Browning, MBChB*,
  2. William H. Fellingham, MBBS,
  3. Edmond J. O’Loughlin, MBBS,
  4. Nicholas A. Brown, MBChB§ and
  5. Michael J. Paech, MBBS, DM**,††
  1. *Department of Anaesthesia and Pain Medicine, Fremantle Hospital; †Department of Anaesthesia, Princess Margaret Hospital; ‡Department of Anaesthesia, Fremantle Hospital, Western Australia, Australia; §Department of Anaesthesia, Crosshouse Hospital, Ayrshire, Scotland; **School of Medicine and Pharmacology, The University of Western Australia; and ††Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Perth, Western Australia, Australia.
  1. Address correspondence to: Roger M. Browning, MBChB, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, 374 Bagot Rd, Subiaco, Western Australia 6008, Australia (e-mail: roger.browning{at}


Objectives Cesarean delivery is commonly performed under regional anesthesia, which is often associated with maternal shivering. This can cause distress and interfere with monitoring. The study objective was to evaluate the antishivering efficacy of ondansetron, which reduces the incidence and severity of shivering in nonobstetric patients. We hypothesized that there would be a significant decrease in the incidence and/or severity of shivering in women who are given intravenous ondansetron 8 mg before combined spinal epidural (CSE) anesthesia, when compared with placebo.

Methods This was a randomized, double-blinded, parallel-group, placebo-controlled trial of 118 women scheduled for elective cesarean surgery. Women received either intravenous ondansetron 8 mg (n = 58) or saline (n = 60) before CSE anesthesia (intrathecal hyperbaric bupivacaine 0.5% 2.2–2.5 mL plus fentanyl 15 μg). The incidence and severity of shivering, measured on a validated 5-point scale, and other outcomes, such as nausea, pruritus, headache, or satisfaction, were assessed at 3 time points during the surgery and postoperative period.

Results The incidence of shivering at any time point did not differ significantly between groups: ondansetron 41% versus placebo 47% (P = 0.54). The incidence of severe shivering at any time was not significantly different: ondansetron 32% versus placebo 33% (P = 0.79). There were no significant differences between the groups for any secondary outcomes.

Conclusions Intravenous ondansetron 8 mg before performing CSE anesthesia in women undergoing elective cesarean delivery does not decrease the incidence or severity of shivering.

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  • The authors declare no conflict of interest.

    Joseph M. Neal, MD, served as editor-in-chief for this article.

    This work is attributed to the Department of Anaesthesia and Pain Medicine, Fremantle Hospital, and Department of Anaesthesia and Pain Medicine, Rockingham Hospital, Western Australia, Australia.

    Funding was received from the Fremantle Hospital Medical Research Foundation.

    Australian New Zealand Clinical Trials Registry ACTRN12609000445279.