High Dose but not Low Dose Granisetron Decreases Incidence and Severity of Post Anesthesia Shivering (PAS) and Postoperative Nausea and Vomiting (PONV) following Lower Abdominal Surgeries under Spinal Anesthesia
Abstract
Background: Post Anesthesia Shivering (PAS) is one of the common complications throughout recovery from general and regional anesthesia. The incidence of this complication is reported to be 40-70% among patients. PAS occurrence depends on various factors such as age, gender and drugs used in anesthesia and surgery time. Granisetron is a serotonin 5HT3 receptor antagonist. Beneficial effects of such drugs have been shown in a limited number of studies. In this study, preventive effects of granisetron in prevention of shivering, nausea and vomiting following spinal anesthesia were evaluated in patients undergoing lower abdominal surgery.
Methods: One hundred and five patients aged 18-60 years and with ASA class I or II who were scheduled to undergo elective lower abdominal surgery under spinal anesthesia were studied in 3 groups of 35 patients. After spinal anesthesia, group L received low dose granisetron with a dose of 10μg/kg, group H received high dose granisetron with a dose of 40 μg/kg and group C received normal saline as placebo. After leaving the operating room, patients were monitored in terms of shivering occurrence, time and severity of it and incidence of nausea and vomiting.
Results: Incidence of shivering, nausea and vomiting was significantly lower in group H than C. (P=0.009 and 0.008, respectively). However, there was no significant difference between L and C or L and H groups in terms of shivering, or nausea and vomiting occurrence. No side effects of granisetron were observed in the study.
Conclusion: High dose granisetron with dose of 40μg/kg significantly reduced the prevalence and severity of PAS and PONV in comparison to placebo.
intravenous butorphanol, ondansetron and tramadol for shivering during regional anesthesia: A prospective randomized double-blind study. Anaesth Pain & Intensive Care. 2013; 17(1):33-9.
Eydi M, Golzari SE, Aghamohammadi D, Kolahdouzan K, Safari S, Ostadi Z. Postoperative Management of Shivering: A Comparison of Pethidine vs. Ketamine. Anesth Pain Med. 2014; 4(2):e15499.
Moslemi F, Rasouli S, Golzari SE, Gaderi M. Remifentanil-Propofol versus Fentanyl-Propofol Intravenous Anesthesia Increases the Risk of Postoperative Shivering in Ambulatory Gynecologic Procedures. Anesth Pain Med. (In press)
Faiz SHR, Rahimzadeh P, Imani F, Bakhtiari A. Intrathecal injection of magnesium sulfate: shivering prevention during cesarean section: a randomized, double-blinded, controlled study. Korean J Anesthesiol. 2013; 65(4):293-8.
Ozer AB, Tuson F, Demirel I, Unlu S, Bayar MK, Erhan OL. The effects of anesthetic technique and ambient temperature on thermoregulation in lower extremity surgery. J Anesth. 2013; 27(4): 528-34.
Taqi A. Can you stop this shivering doctor?. Anaesth Pain & Intensive Care. 2013; 17(1):4-5.
Iqbal A, Ahmed A, Rudra A, Wankhede RG, Sengupta S, Das T, et al. Prophylactic granisetron vs pethidine for the prevention of postoperative shivering: a randomized control trial. Indian J Anaesth. 2009; 53(3):330-4.
Abdollahi MH, Forouzannia SK, Bagherinasab M, Barzegar K, Fekri A, Sarebanhassanabadi M, et al. The effect of ondansetron and meperedin on preventing shivering after off-pump coronary artery bypass graft. Acta Med Iran. 2012; 50(6):395-8.
Tsai Ye, Chu KS. A comparison of tramadol, amitryptiline and meperidine for post epidural anesthetic shivering in parturient. Anesth analg. 2001; 93(5):1288-92.
Sagir O, Gulhas N, Yucel TA, Begee Z, Ersoy O. Control of shivering during regional anesthesia:prophylactic ketamine and granisetron. Acta Anaesiol Scand. 2007; 51(1):44-9.
Chan AM, Ng KF, Tong EW, Jan GS. Control of shiver¬ing under regional anesthesia in obstetric patients with tramadol. Can J Anaesth. 1999; 46(3):253-58 .
Bock M, Sinner B, Gottlicher M, Simon E, Martin E, Motsch J. Involvement of serotonergic pathways in pos¬tanesthetic cold defence: dolasetron prevents shiver¬ing. J Thermal Biol. 2002; 27(2):159-66.
Golzari SE, Mahmoodpoor A. Factors Contributing to Recovery From Anesthesia and Postoperative Nausea and Vomiting. JAMA Facial Plast Surg. 2015; 17(5):385.
Carlisle JB, Stevenson CA. Drugs for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2006; (3):CD004125.
Fuji Y, Tanka H, Toyooka H. Granisetron prevents nausea and vomiting during spinal anesthesia for caesarean section. Acta Anaesthesiol Scand. 1998; 42(3):312–5.
Gupta S, Choudhary R. A Comparative Clinical Study Of Prevention Of Post-Operative Nausea And Vomiting Using Granisetron And Ondansetron In Laparoscopic Surgeries. The Internet J Anesthesiology. 2009. 26 (1). http://ispub.com/IJA/26/1/4231 (Last accessed on 6/12/2016)
Eldaba AA, Amir YM. Premedication with granisetron reduces shivering during spinal anaesthesia in children. Anaesth Intensive Care. 2012; 40(1):150-3.
Yousuf M, Haider SA, Aziz MM, Waris S. Spinal anaesthesia; comparison between prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia in patients undergoing lower abdominal surgeries. Professional Med J. 2015. 22(8):1029-1033.
Shakya S, Chatoverdi A, Sah BP. Prophylactic low dose ketamine and ondansetron for prevention of shivering during spinal anaesthesia. J Anaesthesiol Clin Pharmacol. 2010; 26(4): 465-9.
Sajedi P, Yaraghi A, Moseli HA. Efficacy of granisetron in preventing postanesthetic shivering. Acta Anaesthesiol Taiwan. 2008; 46(4):166¬¬¬¬-70.
Generali J, Cada D. Off-Label Drug Uses-Granisetron:Postanesthetic Shivering. Hospital pharmacy. 2007; 42(5):424-427.
Kim MS, Kim DW, Woo SH, Yon JH, Lee S. Effect of ramosetron on shivering during spinal anesthesia. Korean J Anesthesiol. 2010; 58(3):256-9.
Kayalha H, Roushanfekr M, Ahmadi M. The Comparison of Ondansetron and Meperidine to Prevent Shivering after Anesthesia in Patients Undergoing Lower Limb Orthopedic Surgeries with General Anesthesia. ZUMS Journal. 2014; 22(92):14-22.
Mahmoud AM, Zaki MA. Granisetron Reduces Shivering after General Anesthesia. Med J Cairo Univer. 2013; 81(2):127-131.
Erhan Y, Erhan E, Aydede H, Yumus O, Yentur A. Ondansetron, granisetron, and dexamethasone compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: A randomized placebo-controlled study. Surg Endosc. 2008; 22(6):1487-92.
| Files | ||
| Issue | Vol 3 No 2 (2017): Spring |
|
| Section | Research Article(s) | |
| Keywords | ||
| granisetron post anesthesia shivering pas postoperative nausea and vomiting PONV | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
