D Bandini Singhal e al. A Compa a i e S udy o P ophylac ic In a enous Ondanse on on Spinal Anaes hesia-
Induced Hypo ension Ve sus Placebo. In . J Med. Pha m. Res., 6 (6): 361-367, 2025
361
In e na ional Jou nal o Medical
and Pha maceu ical Resea ch
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O iginal A icle
A Compa a i e S udy o P ophylac ic In a enous Ondanse on on Spinal
Anaes hesia-Induced Hypo ension Ve sus Placebo
D Bandini Singhal1, D . P ana Puja i2, D Ajay Kuma Sinha3
1 MD Anaes hesia Depa men o Anaes hesiology, C i ical Ca e, Pain and Pallia i e Medicine, GMC Haldwani, Naini al,
U a akhand.
2 Assis an P o esso , Depa men o Anaes hesiology, C i ical Ca e, Pain and Pallia i e Medicine, GMC Haldwani, Naini al,
U a akhand.
3 P o esso , Depa men o Anaes hesiology, C i ical Ca e, Pain and Pallia i e Medicine, GMC Haldwani, Naini al, U a akhand.
A B S T R A C T
Co esponding Au ho :
D Bandini Singhal
MD Anaes hesia Depa men o
Anaes hesiology, C i ical Ca e,
Pain and Pallia i e Medicine, GMC
Haldwani, Naini al, U a akhand.
Recei ed: 18-09-2025
Accep ed: 09-10-2025
A ailable online: 12-11-2025
Backg ound: Spinal anaes hesia is widely used o lowe abdominal and lowe
limb su ge ies bu is equen ly complica ed by hypo ension and b adyca dia,
leading o signi ican pe iope a i e mo bidi y. The Bezold–Ja isch e lex, media ed
ia se o onin (5-HT₃) ecep o s, is implica ed in his esponse. Ondanse on, a 5-
HT₃ an agonis ou inely used o p ophylaxis o pos ope a i e nausea and
omi ing.
Aim: To e alua e he e icacy o p ophylac ic in a enous ondanse on in educing
he incidence o spinal anaes hesia-induced hypo ension compa ed wi h placebo.
Ma e ials and Me hods: This p ospec i e, andomised, double-blind, compa a i e
s udy was conduc ed on 76 ASA I–II pa ien s aged 18–60 yea s unde going elec i e
non-obs e ic su ge ies unde spinal anaes hesia. Pa ien s we e andomised in o wo
g oups: G oup A (Con ol, n=38) ecei ed 10 ml o no mal saline, while G oup B
(Ondanse on, n=38) ecei ed 4 mg ondanse on dilu ed in 10 ml saline,
adminis e ed i e minu es be o e spinal anaes hesia. All pa ien s we e p eloaded
wi h Ringe ’s Lac a e (20 ml/kg). Spinal anaes hesia was pe o med wi h 3.0 ml o
0.5% hype ba ic bupi acaine a L3–L4. Hemodynamic pa ame e s (SBP, DBP,
MAP, HR, SpO₂) we e eco ded a baseline and a egula in e als up o 30
minu es.
Resul s: The incidence o hypo ension was signi ican ly lowe in he ondanse on
g oup (28.9%) compa ed wi h con ols (55.3%, p=0.02). B adyca dia (7.9% s.
26.3%, p=0.03), nausea (7.9% s. 34.2%, p=0.005), and mephen e mine
equi emen (21.1% s. 47.4%, p=0.01) we e also educed. SBP, DBP, and MAP
we e consis en ly be e main ained wi h ondanse on. No signi ican di e ences
we e obse ed in omi ing o shi e ing.
Conclusion: P ophylac ic in a enous ondanse on (4 mg) signi ican ly educes he
incidence o spinal anaes hesia-induced hypo ension, b adyca dia, and nausea
while imp o ing hemodynamic s abili y and educing asop esso use.
Ondanse on may se e as a sa e and e ec i e adjunc in ou ine anaes he ic
p ac ice.
Copy igh © In e na ional Jou nal o
Medical and Pha maceu ical Resea ch
Keywo ds: Spinal anaes hesia, Hypo ension, Ondanse on, Bezold–Ja isch e lex,
B adyca dia.
INTRODUCTION
Spinal anaes hesia has emained one o he mos equen ly employed egional anaes hesia echniques wo ldwide since i s
in oduc ion by Augus Bie in 1898. I is conside ed sa e, cos -e ec i e, and eliable, p o iding p o ound analgesia and
muscle elaxa ion o su ge ies in ol ing he lowe abdomen, pel is, and lowe ex emi ies. Compa ed o gene al
anaes hesia, i o e s ad an ages such as apid onse , minimal d ug equi emen , supe io pos ope a i e pain elie ,
D Bandini Singhal e al. A Compa a i e S udy o P ophylac ic In a enous Ondanse on on Spinal Anaes hesia-
Induced Hypo ension Ve sus Placebo. In . J Med. Pha m. Res., 6 (6): 361-367, 2025
362
dec eased isk o aspi a ion, ea ly ambula ion, and educed opioid consump ion. These ac o s con ibu e o i s widesp ead
use ac oss a ious su gical special ies.1
Howe e , spinal anaes hesia is no wi hou complica ions. The mos signi ican and common hemodynamic dis u bances
associa ed wi h i a e hypo ension and b adyca dia. Repo ed incidences ange om 30–40% in non-obs e ic su gical
popula ions o nea ly 60% in obs e ic pa ien s. Hypo ension is ypically de ined as ei he a dec ease in sys olic blood
p essu e (SBP) ≥20% om baseline o an absolu e SBP <100 mmHg. I a ises p ima ily due o sympa he ic blockade
leading o sys emic asodila a ion, dec eased enous e u n, and educed ca diac ou pu . Addi ionally, ac i a ion o he
Bezold-Ja isch Re lex (BJR)—a ca dioinhibi o y esponse media ed by se o onin (5-HT₃) ecep o s in he hea — u he
con ibu es o he iad o hypo ension, b adyca dia, and asodila ion.2
The clinical implica ions o spinal anaes hesia-induced hypo ension (SAIH) a e conside able. E en ansien hypo ension
can comp omise o gan pe usion, po en ially esul ing in myoca dial ischaemia, ce eb al hypope usion, acu e kidney
inju y, o inc eased pe iope a i e mo bidi y. The elde ly, pa ien s wi h ca dio ascula como bidi ies, and pa u ien s a e
pa icula ly ulne able. The e o e, s a egies o p e en o a enua e SAIH ha e been he ocus o con inuous esea ch.3
P e en i e measu es include p eloading and co-loading wi h c ys alloids o colloids, pha macologic suppo wi h
asop esso s such as phenyleph ine o ephed ine, physical measu es like leg w apping o T endelenbu g posi ioning, and
pha macological adju an s a ge ing he pa hophysiology o SAIH. In his ega d, ondanse on, a selec i e 5-HT₃ ecep o
an agonis widely used o p ophylaxis o pos ope a i e nausea and omi ing (PONV), has gained in e es .4
The a ionale s ems om i s abili y o block 5-HT₃ ecep o s implica ed in he BJR. Se o onin eleased in he le en icle
du ing educed enous e u n ac i a es hese ecep o s, inducing b adyca dia and asodila ion. Ondanse on an agonises
hese ecep o s, po en ially blun ing he e lex and s abilising hemodynamics. Se e al s udies ha e explo ed his concep .
Ma ashi e al.5 (2013) showed ha ondanse on signi ican ly educed hypo ension and b adyca dia. Simila ly, Shah e al.
(2016)6 demons a ed a lowe incidence o hypo ension and asop esso equi emen wi h p ophylac ic ondanse on in
elde ly pa ien s. Mo e ecen ly, Bhiwal e al.7 (2021) epo ed a ou able ou comes in pa u ien s unde going caesa ean
deli e y.
Despi e encou aging e idence, esul s emain inconsis en . Fo example, Salih e al.8 (2021) ound no signi ican di e ence
in hypo ension a es bu epo ed educed shi e ing wi h ondanse on. Va iabili y in pa ien popula ions, d ug dosages,
iming o adminis a ion, and de ini ions o hypo ension con ibu e o hese disc epancies. Fu he mo e, da a om non-
obs e ic Indian popula ions a e limi ed, pa icula ly om he Kumaon egion.
Gi en he high p e alence o SAIH and he po en ial dual bene i o ondanse on (hemodynamic s abili y and an iemesis),
his s udy was unde aken o e alua e he p ophylac ic e ec o in a enous ondanse on compa ed wi h placebo in adul
pa ien s unde going elec i e non-obs e ic su ge ies unde spinal anaes hesia.
The p ima y ou come was he incidence o hypo ension. Seconda y ou comes included incidence o b adyca dia,
asop esso equi emen , nausea, omi ing, and shi e ing. By analysing hese pa ame e s, he s udy aimed o cla i y
ondanse on’s ole in ou ine anaes hesia p ac ice and i s possible in eg a ion in o s anda d p e en i e s a egies o SAIH.
AIM AND OBJECTIVES
Aim
To e alua e he e ec o p ophylac ic in a enous ondanse on on he incidence o spinal anaes hesia-induced
hypo ension in adul pa ien s unde going elec i e non-obs e ic su ge ies, as compa ed wi h placebo.
Objec i es
P ima y Objec i e:
• To de e mine he e ec i eness o in a enous ondanse on (4 mg) in p e en ing spinal anaes hesia-induced
hypo ension.
Seconda y Objec i es:
1. To assess he impac o ondanse on on he incidence o b adyca dia du ing spinal anaes hesia.
2. To e alua e he equi emen o asop esso suppo (mephen e mine) in pa ien s ecei ing ondanse on e sus
placebo.
3. To compa e he occu ence o nausea, omi ing, and shi e ing be ween he wo g oups.
MATERIALS AND METHODS
S udy Design and Se ing
This was a p ospec i e, andomised, double-blind compa a i e s udy conduc ed a he Depa men o Anaes hesiology,
C i ical Ca e, Pain and Pallia i e Medicine, Go e nmen Medical College and D . Sushila Tiwa i Go e nmen Hospi al,
D Bandini Singhal e al. A Compa a i e S udy o P ophylac ic In a enous Ondanse on on Spinal Anaes hesia-
Induced Hypo ension Ve sus Placebo. In . J Med. Pha m. Res., 6 (6): 361-367, 2025
363
Haldwani (U a akhand). The s udy du a ion was 18 mon hs ollowing app o al om he Ins i u ional E hics Commi ee
(IEC Reg. No. 744/IEC/R-06-09-2023) and egis a ion wi h he Clinical T ials Regis y o India (CTRI/2024/03/063398).
Sample Size
A o al o 76 pa ien s ul illing he eligibili y c i e ia we e en olled and andomised in o wo equal g oups (n=38 each).
Inclusion C i e ia
• Adul pa ien s aged 18–60 yea s
• Ame ican Socie y o Anes hesiologis s (ASA) physical s a us I o II
• BMI 18.5–24.9 kg/m²
• Elec i e non-obs e ic su ge ies unde spinal anaes hesia
Exclusion C i e ia
• Pa ien e usal
• P egnancy
• Con aindica ions o spinal anaes hesia (e.g., spinal de o mi ies, in ec ion a punc u e si e)
• Known hype sensi i i y o ondanse on
• Como bidi ies (hype ension, diabe es, as hma, conduc ion blocks, ube culosis)
• Con e sion o gene al anaes hesia
Randomisa ion and Blinding
G oup alloca ion was achie ed using opaque sealed en elopes. Pa ien s we e andomly assigned in o:
• G oup A (Con ol): 10 ml o 0.9% no mal saline IV
• G oup B (Ondanse on): 4 mg ondanse on dilu ed in 10 ml no mal saline IV
Bo h he pa ien and he assessing anaes hesiologis we e blinded o g oup alloca ion.
P ocedu e
All pa ien s en olled in he s udy we e admi ed o he p eope a i e a ea a e con i ming as ing s a us o a leas eigh
hou s and i ness o anaes hesia. An 18-gauge in a enous cannula was secu ed in a pe iphe al ein unde asep ic
p ecau ions. Each pa ien was p eloaded wi h Ringe ’s Lac a e solu ion a a dose o 20 ml/kg o e 15–20 minu es p io
o he ini ia ion o spinal anaes hesia o coun e ac he an icipa ed educ ion in enous e u n and o minimise he isk o
spinal anaes hesia-induced hypo ension. S anda d moni o ing de ices we e a ached, including a non-in asi e blood
p essu e (NIBP) cu , con inuous elec oca diog aphy (ECG), and a pulse oxime e (SpO₂), and baseline eadings we e
eco ded o all pa ame e s.
The s udy d ug was p epa ed by an independen anaes hesia assis an no in ol ed in pa ien assessmen . I was
adminis e ed in a enously as a slow bolus injec ion o e 10 seconds, i e minu es be o e ini ia ion o spinal anaes hesia.
Pa ien s in he ondanse on g oup ecei ed 4 mg ondanse on dilu ed in 10 ml o no mal saline, while hose in he con ol
g oup ecei ed 10 ml o no mal saline only.
Spinal anaes hesia was adminis e ed wi h he pa ien in a si ing posi ion. A e s ic asep ic p epa a ion and d aping, a
midline lumba punc u e was pe o med a he L3–L4 in e e eb al space using a 25G Quincke spinal needle. Once ee
low o ce eb ospinal luid (CSF) was ob ained, 3.0 ml o 0.5% hype ba ic bupi acaine was injec ed in a hecally o e
10–15 seconds. The needle was wi hd awn, and pa ien s we e immedia ely posi ioned supine o ensu e uni o m cephalad
sp ead o he local anaes he ic.
Hemodynamic pa ame e s, namely sys olic blood p essu e (SBP), dias olic blood p essu e (DBP), mean a e ial
p essu e (MAP), hea a e (HR), and oxygen sa u a ion (SpO₂), we e con inuously moni o ed and documen ed a
p ede ined in e als. Readings we e aken a baseline (p io o spinal injec ion), hen e e y h ee minu es o he i s 15
minu es, and subsequen ly a i e-minu e in e als un il 30 minu es pos -block.
Ad e se hemodynamic e en s we e managed acco ding o s anda d p o ocol. Hypo ension, de ined as a all in SBP o
≥20% om baseline, was p omp ly ea ed wi h in a enous boluses o mephen e mine 6 mg. B adyca dia, de ined as
HR <50 bea s pe minu e, was managed wi h in a enous a opine 0.6 mg. Incidences o nausea, omi ing, and
shi e ing we e also eco ded h oughou he pe iope a i e pe iod and documen ed o compa ison be ween g oups.
S a is ical Analysis
All collec ed da a we e compiled, coded, and en e ed in o a Mic oso Excel sp eadshee and subsequen ly analysed using
S a is ical Package o Social Sciences (SPSS) e sion 23.0 (IBM Co p., A monk, NY, USA). Con inuous a iables such
as age, weigh , heigh , body mass index (BMI), sys olic blood p essu e (SBP), dias olic blood p essu e (DBP), mean a e ial
p essu e (MAP), and hea a e (HR) we e exp essed as mean ± s anda d de ia ion (SD). The compa ison o hese
con inuous pa ame e s be ween he wo s udy g oups (ondanse on s. con ol) was pe o med using he unpai ed S uden ’s
- es a e con i ming no mal dis ibu ion o da a. Ca ego ical a iables, including sex dis ibu ion, ASA physical s a us,
D Bandini Singhal e al. A Compa a i e S udy o P ophylac ic In a enous Ondanse on on Spinal Anaes hesia-
Induced Hypo ension Ve sus Placebo. In . J Med. Pha m. Res., 6 (6): 361-367, 2025
364
incidence o hypo ension, b adyca dia, nausea, omi ing, shi e ing, and equi emen o asop esso s, we e exp essed as
numbe s and pe cen ages. These we e analysed using he Chi-squa e es o Fishe ’s exac es , as app op ia e, depending
on he expec ed equency o alues in con ingency ables. Fo all s a is ical es s, a p- alue <0.05 was conside ed o
indica e s a is ical signi icance.
RESULTS
Table 1. Demog aphic and baseline cha ac e is ics
Pa ame e
Ondanse on G oup (n=38)
Con ol G oup (n=38)
p- alue
Age (yea s, mean ± SD)
38.9 ± 11.8
38.0 ± 11.5
0.73
Sex (M/F)
25/13
27/11
0.64
ASA G ade I/II
8/30
7/31
0.73
BMI (kg/m²)
20.52 ± 1.83
20.53 ± 1.68
0.98
The demog aphic and baseline cha ac e is ics o pa ien s in he wo g oups we e compa able, ensu ing p ope
andomisa ion and elimina ing selec ion bias. The mean age o pa icipan s in he ondanse on g oup was 38.9 ± 11.8 yea s,
while in he con ol g oup i was 38.0 ± 11.5 yea s, wi h no s a is ically signi ican di e ence (p = 0.73). The sex dis ibu ion
also showed simila i y be ween g oups, wi h a male- o- emale a io o 25:13 in he ondanse on g oup and 27:11 in he
con ol g oup (p = 0.64). Mos pa ien s in bo h g oups belonged o ASA physical s a us II (78.9% in he ondanse on g oup
s. 81.6% in he con ol g oup), while he emainde we e ASA I; his di e ence was no signi ican (p = 0.73). The mean
body mass index (BMI) was almos iden ical be ween he g oups (20.52 ± 1.83 s. 20.53 ± 1.68, p = 0.98). These indings
con i m ha bo h g oups we e well ma ched in e ms o baseline demog aphic and clinical cha ac e is ics, hus allowing a
alid compa ison o ou comes wi hou con ounding due o pa ien a iabili y.
Table 2. Sys olic blood p essu e ends (mmHg)
Time
Ondanse on (mean ± SD)
Con ol (mean ± SD)
p- alue
Baseline
121.3 ± 18.9
121.4 ± 11.6
0.98
6 min
112.9 ± 14.7
96.6 ± 24.1
0.001*
12 min
111.1 ± 13.1
96.5 ± 23.7
0.002*
20 min
109.3 ± 14.0
95.2 ± 22.2
0.001*
30 min
110.6 ± 14.0
94.0 ± 20.9
<0.001*
Sys olic blood p essu e (SBP) emained signi ican ly be e main ained in he ondanse on g oup compa ed o con ols
h oughou he obse a ion pe iod. A baseline, SBP alues we e nea ly iden ical be ween g oups (121.3 s. 121.4 mmHg,
p = 0.98), con i ming compa abili y. Howe e , beginning a 6 minu es pos -spinal block, he con ol g oup exhibi ed a
ma ked and pe sis en decline in SBP, wi h mean alues signi ican ly lowe han hose in he ondanse on g oup a all
subsequen ime poin s (p < 0.01). By 30 minu es, mean SBP in he ondanse on g oup was 110.6 ± 14.0 mmHg, whe eas
i ell o 94.0 ± 20.9 mmHg in con ols (p < 0.001). These esul s indica e ha ondanse on p o ided g ea e hemodynamic
s abili y by a enua ing he all in sys olic blood p essu e ollowing spinal anaes hesia.
Table 3. Mean a e ial p essu e (MAP, mmHg)
Time
Ondanse on (mean ± SD)
Con ol (mean ± SD)
p- alue
Baseline
91.1 ± 15.9
93.4 ± 7.9
0.42
6 min
85.5 ± 14.6
72.2 ± 13.5
<0.001*
15 min
81.9 ± 13.6
71.7 ± 12.9
0.001*
30 min
83.4 ± 13.9
70.6 ± 12.3
<0.001*
The mean a e ial p essu e (MAP) alues a baseline we e compa able be ween he wo g oups (91.1 s. 93.4 mmHg, p =
0.42). Following spinal anaes hesia, pa ien s in he con ol g oup expe ienced a mo e p onounced decline in MAP
compa ed o hose who ecei ed ondanse on. A 6 minu es, MAP d opped signi ican ly in he con ol g oup (72.2 ± 13.5
mmHg) e sus he ondanse on g oup (85.5 ± 14.6 mmHg, p < 0.001). This end pe sis ed h oughou he moni o ing
pe iod, wi h ondanse on consis en ly main aining highe MAP alues a 15 minu es (81.9 s. 71.7 mmHg, p = 0.001) and
30 minu es (83.4 s. 70.6 mmHg, p < 0.001). These indings clea ly demons a e ha p ophylac ic ondanse on con ibu ed
o imp o ed main enance o pe usion p essu e and o e all hemodynamic s abili y compa ed o placebo.
Table 4. Incidence o hypo ension, b adyca dia, and ad e se e ec s
Va iable
Ondanse on G oup (%)
Con ol G oup (%)
p- alue
Hypo ension
28.9
55.3
0.02*
B adyca dia
7.9
26.3
0.03*
Nausea
7.9
34.2
0.005*
D Bandini Singhal e al. A Compa a i e S udy o P ophylac ic In a enous Ondanse on on Spinal Anaes hesia-
Induced Hypo ension Ve sus Placebo. In . J Med. Pha m. Res., 6 (6): 361-367, 2025
365
Vomi ing
5.3
10.5
0.47
Shi e ing
13.2
18.4
0.56
Mephen e mine use
21.1
47.4
0.01*
The incidence o ad e se hemodynamic and pe iope a i e e en s was no ably lowe in he ondanse on g oup compa ed o
con ols. Hypo ension occu ed in 28.9% o pa ien s ecei ing ondanse on e sus 55.3% in he con ol g oup (p = 0.02),
while b adyca dia was also signi ican ly educed (7.9% s. 26.3%, p = 0.03). Simila ly, he incidence o nausea was
ma kedly lowe wi h ondanse on (7.9% s. 34.2%, p = 0.005). No signi ican di e ences we e obse ed o omi ing
(5.3% s. 10.5%, p = 0.47) o shi e ing (13.2% s. 18.4%, p = 0.56). Impo an ly, he equi emen o asop esso suppo
wi h mephen e mine was signi ican ly educed in he ondanse on g oup (21.1% s. 47.4%, p = 0.01). These indings
demons a e ha p ophylac ic ondanse on no only educed he incidence o spinal anaes hesia-induced hypo ension and
b adyca dia bu also imp o ed pa ien com o by lowe ing nausea and dec easing asop esso equi emen .
G aph 1. Incidence o Hypo ension (%)
The incidence o hypo ension was signi ican ly lowe in pa ien s who ecei ed p ophylac ic ondanse on compa ed o he
con ol g oup (28.9% s. 55.3%). This demons a es ha ondanse on e ec i ely educed he occu ence o spinal
anaes hesia-induced hypo ension by nea ly hal , highligh ing i s p o ec i e ole in main aining pe iope a i e hemodynamic
s abili y.
G aph 2. Sys olic Blood P essu e T ends (mmHg)
A baseline, sys olic blood p essu e (SBP) was almos iden ical be ween he wo g oups (121.3 mmHg in he ondanse on
g oup s. 121.4 mmHg in he con ol g oup; di e ence 0.1 mmHg), con i ming compa abili y. Howe e , ollowing
spinal anaes hesia, he con ol g oup showed a ma ked and sus ained decline in SBP, while he ondanse on g oup
main ained ela i ely s able alues. By 30 minu es, he mean SBP emained abo e 110 mmHg in he ondanse on g oup
compa ed o only 94 mmHg in con ols, indica ing ha ondanse on e ec i ely a enua ed he all in sys olic p essu e and
p ese ed hemodynamic s abili y.
G aph 3. Mean A e ial P essu e T ends (mmHg)
D Bandini Singhal e al. A Compa a i e S udy o P ophylac ic In a enous Ondanse on on Spinal Anaes hesia-
Induced Hypo ension Ve sus Placebo. In . J Med. Pha m. Res., 6 (6): 361-367, 2025
366
DISCUSSION
The p esen s udy demons a ed ha p ophylac ic in a enous ondanse on signi ican ly educed he incidence o spinal
anaes hesia-induced hypo ension (SAIH), b adyca dia, and nausea while lowe ing asop esso equi emen . Hemodynamic
s abili y, e lec ed by highe SBP, DBP, and MAP alues, was be e main ained in he ondanse on g oup compa ed o
placebo.
Baseline demog aphic cha ac e is ics, including age, sex, ASA g ading, and BMI, we e compa able be ween he wo
g oups, ensu ing ha ou come di e ences could be a ibu ed o he in e en ion a he han con ounding ac o s. Simila
indings o balanced baseline demog aphics ha e been epo ed in s udies by Raghu e al.9 (2019) and Bhiwal e al.7
(2021), bo h o which also highligh ed he impo ance o p ope andomisa ion in ials e alua ing ondanse on’s
p ophylac ic ole.
In ou s udy, he incidence o hypo ension was signi ican ly lowe in he ondanse on g oup (28.9%) compa ed o con ols
(55.3%, p = 0.02). These indings a e consis en wi h Ma ashi e al.5 (2013), who epo ed ha none o he pa ien s
ecei ing ondanse on de eloped hypo ension, compa ed o 12% in he placebo g oup. Simila ly, Shah e al.6 (2016)
demons a ed educed hypo ension in elde ly pa ien s (46% wi h ondanse on s. 68% wi h placebo). B adyca dia was also
signi ican ly educed in ou s udy (7.9% s. 26.3%, p = 0.03). This aligns wi h Raghu e al.9 (2019), who epo ed ewe
cases o b adyca dia in he ondanse on g oup (4 pa ien s) compa ed o con ols (13 pa ien s, p = 0.0176).
Rega ding nausea, he ondanse on g oup showed a ma kedly lowe incidence (7.9% s. 34.2%, p = 0.005). This an ieme ic
e ec is well documen ed in li e a u e; Baig e al.10 (2017) simila ly obse ed a signi ican educ ion in nausea and
omi ing wi h ondanse on compa ed o placebo. Vomi ing and shi e ing, howe e , we e no signi ican ly di e en
be ween g oups in ou s udy. This inding is compa able o Salih e al.8 (2021), who also epo ed no signi ican e ec o
ondanse on on omi ing bu obse ed educed shi e ing. Con e sely, De ko a e al.11 (2021) demons a ed signi ican
educ ion in shi e ing among obs e ic pa ien s, highligh ing possible popula ion-speci ic di e ences.
The equi emen o mephen e mine was signi ican ly lowe in he ondanse on g oup (21.1% s. 47.4%, p = 0.01), which
is compa able o indings by Mendonça e al.12 (2021), who epo ed signi ican ly lowe ephed ine equi emen s among
pa ien s ecei ing ondanse on.
Ou s udy showed ha sys olic blood p essu e was signi ican ly be e main ained in he ondanse on g oup om 6 minu es
onwa ds, wi h mean alues consis en ly abo e 110 mmHg compa ed o <100 mmHg in con ols (p < 0.01 a all ime poin s).
These esul s a e suppo ed by Shah e al.6 (2016), who also demons a ed ha SBP was signi ican ly highe in he
ondanse on g oup a mul iple in e als pos -spinal anaes hesia. Simila ly, De ko a e al.11 (2021) obse ed ha SBP
alues we e signi ican ly p ese ed wi h ondanse on, pa icula ly be ween 3–18 minu es a e spinal anaes hesia in
caesa ean sec ion pa ien s.
Mean a e ial p essu e (MAP) was also signi ican ly highe in he ondanse on g oup a 6, 15, and 30 minu es compa ed
wi h con ols. A 30 minu es, mean MAP was 83.4 mmHg in he ondanse on g oup e sus 70.6 mmHg in con ols (p <
0.001). These esul s a e in ag eemen wi h Baig e al.10 (2017), who epo ed signi ican ly ewe episodes o hypo ension
and highe MAP alues in he ondanse on g oup. In con as , Owczuk e al.13 (2015) ound no signi ican educ ion in he
incidence o hypo ension wi h ondanse on in elde ly pa ien s, al hough hey no ed a smalle decline in SBP and MAP,
sugges ing a leas pa ial bene i .
Taken oge he , he esul s o ou s udy ein o ce he e idence ha p ophylac ic ondanse on educes he incidence and
se e i y o spinal anaes hesia-induced hypo ension and b adyca dia, dec eases he need o asop esso suppo , and
p o ides he added bene i o educing nausea. The mechanism is a ibu able o an agonism o se o onin-media ed Bezold–
Ja isch Re lex (BJR), p e en ing agally media ed b adyca dia and asodila ion.
Limi a ions
Ou s udy had some limi a ions. The ela i ely small sample size (n = 76) limi ed he powe o subg oup analyses. High-
isk g oups such as elde ly pa ien s >60 yea s, obs e ic pa ien s, and hose wi h como bidi ies we e excluded, which may
es ic gene alisabili y. Moni o ing was limi ed o 30 minu es, whe eas spinal anaes hesia-induced hypo ension may pe sis
beyond his pe iod. Fu u e la ge-scale, mul icen ic s udies including di e se popula ions a e equi ed o con i m he
gene al applicabili y o hese indings.
CONCLUSION
P ophylac ic adminis a ion o 4 mg in a enous ondanse on signi ican ly educed he incidence o spinal anaes hesia-
induced hypo ension, b adyca dia, and nausea, while imp o ing hemodynamic s abili y and dec easing asop esso
equi emen compa ed wi h placebo. No majo ad e se e ec s we e obse ed. Gi en i s widesp ead a ailabili y, sa e y
D Bandini Singhal e al. A Compa a i e S udy o P ophylac ic In a enous Ondanse on on Spinal Anaes hesia-
Induced Hypo ension Ve sus Placebo. In . J Med. Pha m. Res., 6 (6): 361-367, 2025
367
p o ile, and addi ional an ieme ic bene i s, ondanse on ep esen s a simple and e ec i e s a egy o mi iga e SAIH in
ou ine anaes hesia p ac ice. La ge , mul icen ic s udies including di e se pa ien g oups a e ecommended o u he
alida e hese indings.
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