Prophylactic mirtazapine and ondansetron for the prevention of post spinal anesthesia shivering in lower abdominal surgeries: a randomized clinical study

Tailyang Mopi; Longjam Eshori; Dhayanithy M.; Vigneshwaravibhava K.; Rohan Deb

doi:10.18203/2320-6012.ijrms20250980

Authors

Tailyang Mopi Department of Anesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
Longjam Eshori Department of Anesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
Dhayanithy M. Department of Anesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
Vigneshwaravibhava K. Department of Anesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
Rohan Deb Department of Anesthesiology, Regional Institute of Medical Sciences, Imphal, Manipur, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20250980

Keywords:

Mirtazapine, Ondansetron, Shivering, Spinal anesthesia

Abstract

Background: Spinal anesthesia is a frequently employed method for administering anesthesia during lower abdominal surgeries and is considered a safe anesthetic approach utilized for both elective and emergency operations. However, potential complications can arise, including hypotension, post-dural puncture headache (PDPH), and shivering. Objective was to evaluate the efficacy of prophylactic mirtazapine and ondansetron in the prevention of post spinal anaesthesia shivering (PSAS) among the patients who underwent lower abdominal surgeries.

Methods: The study groups were divided into two, named group M and group O. The total sample size was 88 (44 patients in each group). Patients in group M received mirtazapine 30 mg tablet (Mirtakem 30) with sips of water and group O received ondansetron 4 mg tablet (Ondem 4) with sips of water.

Results: The incidence of PSAS among the patients in mirtazapine and ondansetron groups were 45.5% and 81.8%. PSAS was significantly higher among the patients in the ondansetron group when compared to the mirtazapine group (p<0.001). The time of onset of shivering was delayed for the patients in the ondansetron group when compared to the patients in the mirtazapine group, but it was not found to be statistically significant.

Conclusions: It could be safely concluded that prophylactic administration of mirtazapine attenuate shivering with minimal hazards in patients scheduled for lower abdominal surgery under spinal anesthesia when compared to ondansetron.

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References

Norris MC. Neuraxial anesthesia. In: Barash PG. Clinical Anesthesia. 8th edn. Lippincott: Williams and Wilkins, Philadelphia, PA, USA; 2017:2273-2343.

Lopez MB. Postanesthetic shivering from pathophysiology to prevention. Rom J Anaesth Intens Care. 2018;25(1):73-81. DOI: https://doi.org/10.21454/rjaic.7518.251.xum

Shukla U, Malhotra K, Prabhakar T. A comparative study of the effect of clonidine and tramadol on post-spinal anesthesia shivering. Indian J Anesth. 2011;55:242-6. DOI: https://doi.org/10.4103/0019-5049.82666

De Witte J, Sessler DI. Perioperative shivering: physiology and pharmacology. Anesthesiology. 2002;96:467-84. DOI: https://doi.org/10.1097/00000542-200202000-00036

Moeen SM, Moeen AM. Intrathecal dexamethasone versus meperidine for prevention of shivering during transurethral prostatectomy: a randomized controlled trial. Acta Anesthesiol Scand. 2017;61:749-57. DOI: https://doi.org/10.1111/aas.12920

Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology. 2001;94(5):888-906. DOI: https://doi.org/10.1097/00000542-200105000-00030

Crowley LJ, Buggy DJ. Shivering and neuraxial anesthesia. Reg Anesth Pain Med. 2008;33(3):241-52. DOI: https://doi.org/10.1016/j.rapm.2007.11.006

Park B, Lee T, Berger K, Park SM, Choi KE, Goodsell TM, et al. Efficacy of nonpharmacological anti-shivering interventions: a systematic analysis. Crit Care Med. 2015;43:1757-66. DOI: https://doi.org/10.1097/CCM.0000000000001014

Abdel-Ghaffar HS, Mohamed SA, Fares KM, Osman MA. Safety and efficacy of dexmedetomidine in treating post spinal anesthesia shivering: a randomized clinically controlled dose-finding trial. Pain Phys. 2016;19(4):243-53. DOI: https://doi.org/10.36076/ppj/2019.19.243

Bansal P, Jain G. Control of shivering with clonidine, butorphanol, and tramadol under spinal anesthesia: a comparative study. Local Reg Anesth. 2011;4:29-34. DOI: https://doi.org/10.2147/LRA.S15366

Safari M, Honarmand A, Negahbari M, Attari M. Prophylactic effects of intrathecal meperidine and intravenous ondansetron on shivering in patients undergoing lower extremity orthopaedic surgery under spinal anesthesia. J Res Pharm Pract. 2014;3(3):94-9. DOI: https://doi.org/10.4103/2279-042X.141105

Theriot J, Wermuth HR, Ashurst JV. Antiemetic serotonin 5-HT3 receptor blockers. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024

Schreiber S, Rigai T, Katz Y, Pick CG. The antinociceptive effect of mirtazapine in mice is mediated through serotonergic, noradrenergic, and opioid mechanisms. Brain Res Bull. 2002;58(6):601-5. DOI: https://doi.org/10.1016/S0361-9230(02)00825-0

Jouryabi AM, Sharami SH, Ghanaie MM, Sedighnejad A, Imantalab V, Sorouri ZR, et al. Comparing the effects of low dose of ketamine, tramadol, and ondansetron in prevention of post spinal anesthesia shivering in cesarean section. Anesth Pain Med. 2021;11(4):e116429. DOI: https://doi.org/10.5812/aapm.116429

Alfonsi P. Postanaesthetic shivering, epidemiology, pathophysiology, and approaches to prevention and management. Drugs. 2001;61(15):2193-205. DOI: https://doi.org/10.2165/00003495-200161150-00004

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;31(1):40-5. DOI: https://doi.org/10.1016/j.rapm.2005.10.010

Majeed A, Venkateswarlu G. Prevention of postspinal anesthesia shivering in lower abdominal surgeries: a randomized controlled study between mirtzapine and dexamethasone. Saudi Med J. 2016;1(3):87-94.

Shakya S, Chaturvedi A, Sah BP. Prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anesthesia. J Anesthesiol Clin Pharmacol. 2010;26(4):465-9. DOI: https://doi.org/10.4103/0970-9185.74586

Lakhe G, Adhikari KM, Khatri K, Maharjan A, Bajracharya A, Khanal H. Prevention of shivering during spinal anesthesia: comparison between tramadol, ketamine and ondansetron. JNMA J Nepal Med Assoc. 2017;56(208):395-400. DOI: https://doi.org/10.31729/jnma.3377

Shen QH, Li HF, Zhou X, Lu Y, Yuan XZ. 5-HT3 receptor antagonists for the prevention of perioperative shivering undergoing spinal anesthesia: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2020;10(10):e038293. DOI: https://doi.org/10.1136/bmjopen-2020-038293

Chen CC, Lin CS, Ko YP, Hung YC, Lao HC, Hsu YW. Premedication with mirtazapine reduces preoperative anxiety and postoperative nausea and vomiting. Anesth Analg. 2008;106(1):109-13. DOI: https://doi.org/10.1213/01.ane.0000289636.09841.bc

He K, Zhao H, Zhou HC. Efficiency and safety of ondansetron in preventing postanesthesia shivering. Ann R Coll Surg Engl. 2016;98(6):358-66. DOI: https://doi.org/10.1308/rcsann.2016.0152