Preoperative granisetron for shivering prophylaxis in cesarean section under spinal anesthesia

Abstract

Background Shivering is one of the common problems during spinal anesthesia and may lead to several complications, interfere with patient monitoring, and is bothersome for the mother while holding her newborn. We performed this prospective, double-blinded, placebo-controlled study to determine the ability of preoperative intravenous (IV) granisetron to prevent or decrease shivering after spinal anesthesia during elective cesarean delivery. Materials and methods A total of 117 ASA I/II parturient women undergoing elective cesarean delivery were enrolled. Patients were randomly allocated into two groups: group G ( n = 58) received 3 mg in 3 ml granisetron intravenously and group P ( n = 59) received 3 ml intravenous normal saline before performing spinal anesthesia. Spinal anesthesia was performed in all patients using 10 mg heavy bupivacaine 0.5% and 15 μg fentanyl. Shivering was graded according to the Wrench score: 0 = no shivering; 1 = piloerection, peripheral vasoconstriction, or peripheral cyanosis without other cause; 2 = visible muscular activity confined to one muscle group; 3 = visible muscular activity in more than one muscle group; and 4 = gross muscular activity involving the entire body. Rescue medication intake, interference with neonatal holding, interference with monitoring, and maternal vomiting in 12 h postoperative as well as tympanic membrane temperature and Apgar score were recorded. Results The percentage of shivering and shivering score value among parturients in both groups did not show significant statistical difference during the study time periods, with a P value greater than 0.05. With respect to rescue medication intake ( P = 0.086) as well as interference with monitoring ( P = 0.653) and neonatal holding ( P = 0.653), there was no statistically significant difference as well. In addition, tympanic membrane temperature ( P = 0.48) and 1-min Apgar score ( P = 0.09) did not show statistically significant difference. Granisetron significantly reduced the incidence of nausea and vomiting during the 12-h postoperative period, with only six (10.3%) mothers in group G complaining of nausea and vomiting in comparison with 16 (27.1%) mothers in group P ( P = 0.036). Conclusion Preoperative intravenous granisetron for shivering prophylaxis in cesarean section under spinal anesthesia did not significantly reduce the incidence or severity of shivering.