Effect of Single-Dose Intravenous Dexamethasone and Ondansetron on Hemodynamic Stability and PONV in Lower-Limb Surgery under Spinal Anesthesia
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Abstract
Background: Spinal anesthetic has improved perioperative care for lower-limb procedures. However, sympathetic blocking can induce considerable hemodynamic instability. While fluid preloading and vasopressors are established preventive interventions, dexamethasone and ondansetron, employed as antiemetics, have lately been studied for their cardiovascular-stabilizing effects. This study compares the effects of preoperative intravenous dexamethasone (8 mg) and ondansetron (8 mg) on hemodynamic stability and postoperative nausea and vomiting during spinal anesthesia.
Methods: 192 ASA I-II patients undergoing elective lower-limb orthopedic surgery under spinal anesthesia at Alkafeel Hospital in Karbala from 2nd September, 2022, to 3rd November, 2024, were assigned to four groups: dexamethasone (Group D), ondansetron (Group O), combination (Group B), and control (Group C). MAP, HR, and SpO₂ incidences of nausea and vomiting were measured at 5, 10, 15, 30, and 60 minutes after spinal block.
Results: MAP and HR did not differ significantly between groups (p = 0.326 and 0.458, respectively). At 5 minutes, Group B had greater MAP (p = 0.001) and HR (p = 0.030) than Group C. No significant differences in SpO₂ levels were seen (p > 0.05). The incidence of nausea was lowest in Group B (2.1%), compared to Group C (14.6%) (p = 0.009). Vomiting occurred in all groups, with zero incidences in Group B.
Conclusion: Combining dexamethasone and ondansetron before lower-limb surgery under spinal anesthesia improved cardiovascular stability and reduced nausea.
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[3] Hu B, Zhou H, Zou X. Hypotension after spinal anaesthesia during caesarean section. Anaesthesia. 2020;75(9):1255.
[4] Ferré F, Martin C, Bosch L, Kurrek M, Lairez O, Minville V. Control of Spinal Anesthesia-Induced Hypotension in Adults. Local Reg Anesth. 2020; 13:39-46.
[5] Šklebar I, Bujas T, Habek D. SPINAL ANAESTHESIA-INDUCED HYPOTENSION IN OBSTETRICS: PREVENTION AND THERAPY. Acta Clin Croat. 2019;58(Suppl 1):90-95.
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[8] Kirsch C, Badwal A, Rabany R, Shabanian J, Dormer CL. Bezold-Jarisch Reflex Presenting With Bradypnea, Bradycardia, and Hypotension Following Combined Spinal Epidural Prior to Cesarean Section: A Case Report. Cureus. 2024;16(2):e53643.
[9] Shen QH, Li HF, Zhou X, Lu Y, Yuan XZ. 5-HT3 receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2020;10(10):e038293.
[10] Owczuk R, Wenski W, Polak-Krzeminska A, Twardowski P, Arszułowicz R, Dylczyk-Sommer A, et al. Ondansetron given intravenously attenuates arterial blood pressure drop due to spinal anesthesia: a double-blind, placebo-controlled study. Reg Anesth Pain Med. 2008;33(4):332-339.
[11] Pang QY, Wang JY, Liang XL, Jiang Y, Liu HL. The safety of perioperative dexamethasone with antiemetic dosage in surgical patients with diabetes mellitus: a systematic review and meta-analysis. Perioper Med (Lond). 2023;12(1):4.
[12] Mølgaard AK, Gasbjerg KS, Mathiesen O, Hägi-Pedersen D, Gögenur I. Dexamethasone vs. placebo modulation of the perioperative blood immune proteome in patients undergoing total knee arthroplasty. BMC Anesthesiol. 2025;25(1):136.
[13] Ashoor TM, Hussien NS, Anis SG, Esmat IM. Dexamethasone blunts postspinal hypotension in geriatric patients undergoing orthopedic surgery: a double blind, placebo-controlled study. BMC Anesthesiol. 2021; 21(1):11.
[14] Hou XM, Chen YJ, Lai L, Liu K, Shen QH. Ondansetron Reduces the Incidence of Hypotension after Spinal Anaesthesia: A Systematic Review and Meta-Analysis. Pharmaceuticals (Basel). 2022;15(12):1588.
[15] Singh PM, Singh NP, Reschke M, Ngan Kee WD, Palanisamy A, Monks DT. Vasopressor drugs for the prevention and treatment of hypotension during neuraxial anaesthesia for Caesarean delivery: a Bayesian network meta-analysis of fetal and maternal outcomes. Br J Anaesth. 2020;124(3):e95-e107.
[16] Heesen M, Klimek M, Hoeks SE, Rossaint R. Prevention of Spinal Anesthesia-Induced Hypotension During Cesarean Delivery by 5-Hydroxytryptamine-3 Receptor Antagonists: A Systematic Review and Meta-analysis and Meta-regression. Anesth Analg. 2016;123(4):977-988.
[17] El Khouly NI, Meligy AM. Randomized controlled trial comparing ondansetron and placebo for the reduction of spinal anesthesia-induced hypotension during elective cesarean delivery in Egypt. Int J Gynaecol Obstet. 2016;135(2):205-209.
[18] Ahmed Ali Fawaz, Ibrahim Mamdouh Esmat, Ahmad Mahmoud Hasseb, Tarek Mohamed Ashoor, Shenouda Nabih Labib. Efficacy of Dexamethasone in Attenuation of Postinduction Hypotension in Geriatric Patients Undergoing General Anesthesia: A Randomized Controlled Trial. QJM: An International Journal of Medicine. 2023;116(Suppl_1):hcad069.096.
[19] Duttala SV, Kumari K, Kumari V, Meshram TM, Sharma A, Sethi P, et al. Dexamethasone for prevention of spinal hypotension during caesarean delivery: a randomised controlled trial. Int J Obstet Anesth. 2025;61:104286.
[20] Mendonça FT, Crepaldi Junior LC, Gersanti RC, de Araújo KC. Effect of ondansetron on spinal anesthesia-induced hypotension in non-obstetric surgeries: a randomised, double-blind and placebo-controlled trial. Braz J Anesthesiol. 2021;71(3):233-240.
[21] Nivatpumin P, Thamvittayakul V. Ephedrine versus ondansetron in the prevention of hypotension during cesarean delivery: a randomized, double-blind, placebo-controlled trial. Int J Obstet Anesth. 2016;27:25-31.
[22] Lee S, Islam N, Ladha KS, Bicket MC, Wijeysundera DN. Prevention of hypotension after neuraxial anesthesia in nonobstetric surgery: a systematic review. Can J Anaesth. 2025;72(5):721-737.
[23] Schmidt AP, Silvello D, Filho CTB, Bergmann D, Ferreira LEC, Nolasco MF, et al. Effects of Neuraxial or General Anesthesia on the Incidence of Postoperative Pulmonary Complications in Patients Undergoing Peripheral Vascular Surgery: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth. 2025; 39(3):724-732.
[24] Ju JW, Kwon J, Yoo S, Lee HJ. Retrospective analysis of the incidence and predictors of postoperative nausea and vomiting after orthopedic surgery under spinal anesthesia. Korean J Anesthesiol. 2023; 76(2):99-106.
[25] Nejadi JR, Shamseh M, Ronasi N, Birjandi M, Karimi A. Comparison of the Effects of Dexamethasone and Ondansetron on the Reduction of Postoperative Nausea and Vomiting following Cesarean Section under Spinal Anesthesia. Curr Rev Clin Exp Pharmacol. 2021;16(1):117-122.
[26] Darvall J, Handscombe M, Maat B, So K, Suganthirakumar A, Leslie K. Interpretation of the four risk factors for postoperative nausea and vomiting in the Apfel simplified risk score: an analysis of published studies. Can J Anaesth. 2021;68(7):1057-1063.
[2] Cai J, Tang M, Wu H, Yuan J, Liang H, Wu X, et al. Association of intraoperative hypotension and severe postoperative complications during non-cardiac surgery in adult patients: A systematic review and meta-analysis. Heliyon. 2023; 9(5):e15997.
[3] Hu B, Zhou H, Zou X. Hypotension after spinal anaesthesia during caesarean section. Anaesthesia. 2020;75(9):1255.
[4] Ferré F, Martin C, Bosch L, Kurrek M, Lairez O, Minville V. Control of Spinal Anesthesia-Induced Hypotension in Adults. Local Reg Anesth. 2020; 13:39-46.
[5] Šklebar I, Bujas T, Habek D. SPINAL ANAESTHESIA-INDUCED HYPOTENSION IN OBSTETRICS: PREVENTION AND THERAPY. Acta Clin Croat. 2019;58(Suppl 1):90-95.
[6] Kinsella SM, Carvalho B, Dyer RA, Fernando R, McDonnell N, Mercier FJ, et al. Consensus Statement Collaborators. International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018;73(1):71-92.
[7] Hung KC, Liu CC, Huang YT, Wu JY, Chen JY, Ko CC, et al. Predictive efficacy of the perfusion index for hypotension following spinal anesthesia in parturient undergoing elective cesarean section: a systematic review and meta-analysis. Diagnostics (Basel). 2023;13(15):2584.
[8] Kirsch C, Badwal A, Rabany R, Shabanian J, Dormer CL. Bezold-Jarisch Reflex Presenting With Bradypnea, Bradycardia, and Hypotension Following Combined Spinal Epidural Prior to Cesarean Section: A Case Report. Cureus. 2024;16(2):e53643.
[9] Shen QH, Li HF, Zhou X, Lu Y, Yuan XZ. 5-HT3 receptor antagonists for the prevention of perioperative shivering undergoing spinal anaesthesia: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2020;10(10):e038293.
[10] Owczuk R, Wenski W, Polak-Krzeminska A, Twardowski P, Arszułowicz R, Dylczyk-Sommer A, et al. Ondansetron given intravenously attenuates arterial blood pressure drop due to spinal anesthesia: a double-blind, placebo-controlled study. Reg Anesth Pain Med. 2008;33(4):332-339.
[11] Pang QY, Wang JY, Liang XL, Jiang Y, Liu HL. The safety of perioperative dexamethasone with antiemetic dosage in surgical patients with diabetes mellitus: a systematic review and meta-analysis. Perioper Med (Lond). 2023;12(1):4.
[12] Mølgaard AK, Gasbjerg KS, Mathiesen O, Hägi-Pedersen D, Gögenur I. Dexamethasone vs. placebo modulation of the perioperative blood immune proteome in patients undergoing total knee arthroplasty. BMC Anesthesiol. 2025;25(1):136.
[13] Ashoor TM, Hussien NS, Anis SG, Esmat IM. Dexamethasone blunts postspinal hypotension in geriatric patients undergoing orthopedic surgery: a double blind, placebo-controlled study. BMC Anesthesiol. 2021; 21(1):11.
[14] Hou XM, Chen YJ, Lai L, Liu K, Shen QH. Ondansetron Reduces the Incidence of Hypotension after Spinal Anaesthesia: A Systematic Review and Meta-Analysis. Pharmaceuticals (Basel). 2022;15(12):1588.
[15] Singh PM, Singh NP, Reschke M, Ngan Kee WD, Palanisamy A, Monks DT. Vasopressor drugs for the prevention and treatment of hypotension during neuraxial anaesthesia for Caesarean delivery: a Bayesian network meta-analysis of fetal and maternal outcomes. Br J Anaesth. 2020;124(3):e95-e107.
[16] Heesen M, Klimek M, Hoeks SE, Rossaint R. Prevention of Spinal Anesthesia-Induced Hypotension During Cesarean Delivery by 5-Hydroxytryptamine-3 Receptor Antagonists: A Systematic Review and Meta-analysis and Meta-regression. Anesth Analg. 2016;123(4):977-988.
[17] El Khouly NI, Meligy AM. Randomized controlled trial comparing ondansetron and placebo for the reduction of spinal anesthesia-induced hypotension during elective cesarean delivery in Egypt. Int J Gynaecol Obstet. 2016;135(2):205-209.
[18] Ahmed Ali Fawaz, Ibrahim Mamdouh Esmat, Ahmad Mahmoud Hasseb, Tarek Mohamed Ashoor, Shenouda Nabih Labib. Efficacy of Dexamethasone in Attenuation of Postinduction Hypotension in Geriatric Patients Undergoing General Anesthesia: A Randomized Controlled Trial. QJM: An International Journal of Medicine. 2023;116(Suppl_1):hcad069.096.
[19] Duttala SV, Kumari K, Kumari V, Meshram TM, Sharma A, Sethi P, et al. Dexamethasone for prevention of spinal hypotension during caesarean delivery: a randomised controlled trial. Int J Obstet Anesth. 2025;61:104286.
[20] Mendonça FT, Crepaldi Junior LC, Gersanti RC, de Araújo KC. Effect of ondansetron on spinal anesthesia-induced hypotension in non-obstetric surgeries: a randomised, double-blind and placebo-controlled trial. Braz J Anesthesiol. 2021;71(3):233-240.
[21] Nivatpumin P, Thamvittayakul V. Ephedrine versus ondansetron in the prevention of hypotension during cesarean delivery: a randomized, double-blind, placebo-controlled trial. Int J Obstet Anesth. 2016;27:25-31.
[22] Lee S, Islam N, Ladha KS, Bicket MC, Wijeysundera DN. Prevention of hypotension after neuraxial anesthesia in nonobstetric surgery: a systematic review. Can J Anaesth. 2025;72(5):721-737.
[23] Schmidt AP, Silvello D, Filho CTB, Bergmann D, Ferreira LEC, Nolasco MF, et al. Effects of Neuraxial or General Anesthesia on the Incidence of Postoperative Pulmonary Complications in Patients Undergoing Peripheral Vascular Surgery: A Randomized Controlled Trial. J Cardiothorac Vasc Anesth. 2025; 39(3):724-732.
[24] Ju JW, Kwon J, Yoo S, Lee HJ. Retrospective analysis of the incidence and predictors of postoperative nausea and vomiting after orthopedic surgery under spinal anesthesia. Korean J Anesthesiol. 2023; 76(2):99-106.
[25] Nejadi JR, Shamseh M, Ronasi N, Birjandi M, Karimi A. Comparison of the Effects of Dexamethasone and Ondansetron on the Reduction of Postoperative Nausea and Vomiting following Cesarean Section under Spinal Anesthesia. Curr Rev Clin Exp Pharmacol. 2021;16(1):117-122.
[26] Darvall J, Handscombe M, Maat B, So K, Suganthirakumar A, Leslie K. Interpretation of the four risk factors for postoperative nausea and vomiting in the Apfel simplified risk score: an analysis of published studies. Can J Anaesth. 2021;68(7):1057-1063.
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How to Cite
1.
Zaidan A, Chouchene I. Effect of Single-Dose Intravenous Dexamethasone and Ondansetron on Hemodynamic Stability and PONV in Lower-Limb Surgery under Spinal Anesthesia. Arch Anesth & Crit Care. 2026;.
