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145]
176 Original article
Studying the effects of granisetron, ketamine, and pethidine on
prevention of shivering induced by spinal anesthesia
Alaa El-Deen M. Sayed
Department of Anesthesiology and Intensive
Care, Faculty of Medicine, Al Azhar University,
Cairo, Egypt
Correspondence to Alaa El-Deen Mahmoud
Sayed, MD, Department of Anesthesiology and
Intensive Care, Faculty of Medicine, Al Azhar
University, Cairo, 71121, Egypt.
Fax: 00203333058644;
e-mail: alaa.deen.1965@gmail.com
Received 6 August 2017
Accepted 12 September 2017
Al-Azhar Assiut Medical Journal
2018, 16:176–183
Introduction
Shivering is distressing for the patients undergoing
surgery both under regional and after general
anesthesia. The main causes for shivering
intraoperatively/postoperatively are temperature loss,
decreased sympathetic tone, and systemic release of
pyrogens [1].
Shivering is unpleasant and causes several undesirable
physiologic consequences such as increase in oxygen
consumption, carbon dioxide production, chances of
myocardial ischemia, infection, bleeding, and minute
ventilation. It also induces hypoxemia and lactic acidosis,
increased intraocular pressure and intracranial pressure,
and interferes with patient monitoring such as ECG,
© 2019 Al Azhar Assiut Medical Journal | Published by Wolters Kluwer - Medknow
Background
Spinal anesthesia avoids the hazards of airway management during general
anesthesia. Shivering is a frequent risk factor in patients undergoing lower half
operations under spinal anesthesia. Premedication with intravenous serotonin
receptor antagonists such as granisetron has been used to overcome this
problem. Ketamine increases arterial pressure and heart rate and may decrease
core-to-peripheral redistribution of heat. Moreover, pethidine which is considered
as a time-tested drug for control of shivering can be of value for shivering
prophylaxis.
Objective
This study evaluates the efficacy of granisetron, ketamine, and pethidine on
shivering in patients undergoing lower half operation under spinal anesthesia.
Patients and methods
A total of 60 patients were assigned to three equal groups: group G received 3 mg
granisetron, group K received 25 mg ketamine, and group P received 25 mg
pethidine 5 min before spinal anesthesia. The incidence of shivering episodes
was recorded at baseline monitoring, intraoperatively, and postoperatively.
Moreover, propagation and regression of motor and sensory block were assessed.
Results
Regarding mean arterial blood pressure, there was significant decrease in group P
in comparison with groups G and K. Regarding decreased incidence of shivering,
there was no significant difference between the study groups. Regarding incidence
of nausea and vomiting, there was significant decrease incidence in group G
compared with groups K and P. Moreover, there was significant difference
regarding faster time to regression of sensory block in group G in comparison
with groups K and P.
Conclusion
In patients undergoing lower half surgery under spinal anesthesia, prophylactic
intravenous administration of 3 mg granisetron, 25 mg ketamine, or 25 mg pethidine
5 min before induction of spinal anesthesia significantly reduced the severity of
shivering. Regression of sensory block was faster with granisetron than ketamine
and pethidine. Moreover, prophylactic granisetron also reduces nausea and
vomiting and the need of antiemetics.
Keywords:
5-hydroxytryptamine 3, granisetron, ketamine, pethidine, shivering, spinal anesthesia
Al-Azhar Assiut Med J 16:176–183
© 2019 Al-Azhar Assiut Medical Journal
1687-1693
noninvasive blood pressure, and oxygen saturation
(SaO2). Spinal anesthesia is known to decrease the
shivering threshold, preceded by core hypothermia
and vasoconstriction above the level of block [2].
Regional anaesthesia may impair thermoregulatory
control, and up to a 57% incidence of shivering
during regional anaesthesia has been reported.
Shivering during neuraxial anesthesia could have
potentially detrimental effects. Regional anesthesia
This is an open access journal, and articles are distributed under the terms
of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
License, which allows others to remix, tweak, and build upon the work
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DOI: 10.4103/AZMJ.AZMJ_38_17
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Granisetron, ketamine, and pethidine for prevention of shivering Sayed
produces vasodilatation, which facilitates core-to-
peripheral redistribution of heat [3].
Various methods are available for the control of
shivering such as nonpharmacological or pharmaco
logical. Nonpharmacological preventing measures
such as fluid warmers, maintaining ambient
operating room temperature, space blankets, surgical
drapes, and active circulating water mattress
have been used. Pharmacological methods including
various drugs such as opioids (pethidine,
pentazocine, and tramadol), α2 agonists (clonidine),
and others such as doxapram, neofam,
neostigmine, and magnesium sulfate have been tried
[4].
Recently, studies on serotonin (5-hydroxytryptamine), a
biological amine found in the brain and the spinal
cord, which has a role in neurotransmission and
thermoregulation, suggest the involvement of
serotonergic system in the control of postanesthetic
shivering. Serotonin antagonism seems to lower the
human thermal set range, thereby reducing metabolic
cold defenses and discomfort associated with
postoperative hypothermia. These 5-hydroxy
tryptamine 3 (5-HT3) receptor antagonists, used as
antiemetics routinely, are easily available and cost-
effective [5].
Ketamine, a competitive N-methyl-d-aspartate
receptor antagonist, is an agent used to decrease
postanesthetic shivering [6]. It increases arterial
pressure, heart rate, and cardiac output because of
direct central sympathetic stimulation and inhibition
of norepinephrine uptake into postganglionic
sympathetic nerve endings, and may decrease core-
to-peripheral redistribution of heat [7]. Thus, it may
be logical to use ketamine in patients who are at risk of
hypothermia.
Pethidine decreases the shivering threshold and is
effective in controlling shivering [8]. Pethidine,
which is considered as a time-tested drug for
control of shivering, can have adverse effects
such as respiratory depression, nausea, and vomiting.
This begs to investigate the efficacy of other
drugs.
Thus, in search of an ideal antishivering agent, we
compared the effect of prophylactic granisetron,
ketamine, or pethidine for the prevention of
intraoperative and postoperative shivering in patients
undergoing elective lower half surgeries under spinal
anesthesia.
177
Patients and methods
For this prospective, randomized, controlled,
parallel-group, effectiveness study, patients of both
sexes, aged between 20 and 50 years, with an ASA
physical status of I–II, with Glasgow coma scale 15,
were eligible if they were scheduled to undergo lower
half surgery under spinal anesthesia such as lower
limb orthopedic surgeries, lower limb plastic
surgeries, or lower abdominal surgeries. Patients
were excluded if have any of the following
exclusion criteria:
(1) Who refused to participate.
(2) Had any contraindications to subarachnoid block.
(3) Had a history of hypersensitivity to studied drugs.
After approval of the departmental ethical committee,
this study was conducted from 15 June 2016 to 22
February 2017, at Al Azhar University Hospitals on 60
patients undergoing lower half surgeries after signing a
written informed consent.
Patients were randomly assigned to receive
granisetron 3 mg (group G), ketamine 25 mg
(group K), or pethidine 25 mg (group P). Each
group contains 20 patients. Study medications were
prepared and presented as identical 10-ml
filled syringes and injected 5 min before spinal
anesthesia.
For eligible patients, demographic information was
collected, and physical examination was performed.
A standardized anesthesia regimen was followed.
Age, weight, height, duration of surgery, and ASA
I/II were recorded and analyzed.
In the preoperative preparation room, nearly 500-ml
crystalloid (lactated ringer’s or normal saline 0.9%) was
given intravenously (i.v.) after insertion of i.v. 18 G
cannula in nondominant hand.
On arrival in the operating room, patients were
monitored for mean arterial blood pressure (MAP),
ECG, and pulse oximeter, and this becomes baseline
monitoring.
After sterilization of the back, spinal anesthesia was
induced at L3–L4, with the patient in the sitting
position, with 3.5 ml (17.5 mg) of 0.5% hyperbaric
bupivacaine after confirmation of free flow of
cerebrospinal fluid through a 25-G Quincke spinal
needle. The patients were then placed in the supine
position.
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178 Al-Azhar Assiut Medical Journal, Vol. 16 No. 2, April-June 2018

Supplemental oxygen was administered through Statistical analysis

facemask at 5 l/min. Maintenance fluids (10 ml/kg
in the first 1 h and 5 ml/kg in the subsequent
hours) were given at room temperature.
Hemodynamic data (MAP, heart rate, SaO2 and
ECG changes), sensory block, motor block,
nausea, vomiting, and shivering were recorded at
5 min interval in the first 15 min and then every
15 min until the end of procedure and then every
1 h for 6 h postoperatively.
The statistical program (SPSS; SPSS Inc., Chicago,
Illinois, USA) for Windows, version 20, was used for
data entry and analysis. Quantitative data were
presented as mean and SD, whereas qualitative data
were presented as frequency distribution. Analysis of
variance was used to compare the means between
groups, followed by post-hoc analysis. The χ 2-test
and Fisher’s exact test were used to compare
between proportions.

Shivering was graded using the following scale [9]:

Results
0, no shivering; 1, piloerection or peripheral
A total of 60 patients were selected and divided into
vasoconstriction but no visible shivering; 2, muscular
three groups of 20 each. Regarding demographic data
activity in only one muscle group; 3, muscular
(age, weight, height, procedure duration, and ASA I/
activity in more than one muscle group but not
II), there were no significant differences between the
generalized; and 4, shivering involving the whole body.
three groups, and regarding the basal monitoring
(MAP, HR, SaO2, ECG, sensory block, motor
During surgery, a shivering score was recorded at 5-
block, nausea, vomiting, and shivering), there were
min intervals. Just 15 min after spinal anesthesia, and
nonsignificant differences among the three groups.
concomitant administration of a prophylactic dose of
one of the study drugs, if grade 3 or 4 shivering was
However, regarding intraoperative MAP, there were
noted, the prophylaxis was regarded as ineffective, and
significant decreases in group P compared with
i.v. meperidine 25 mg was administered.
both groups G and K at 5, 10, 15, and 60 min, with
P values of 0.035, 0.003, 0.006 and 0.042, respectively
Hallucination as an adverse effect was defined as a
(Table 2), whereas there were nonsignificant
false sensory experience where the patients reported
differences between groups G and K regarding MAP.
they saw, heard, smelled, tasted, and felt something
that was nonexistent. The attending anesthetist also
Regarding postoperative MAP, there were
assessed the degree of sedation on a five-point scale:
nonsignificant differences among the three groups.
1, fully awake and oriented; 2, drowsy; 3, eyes closed
but arousable to command; 4, eyes closed but
Regarding heart rate, oxygen saturation, and ECG,
arousable to mild physical stimulation; 5, eyes
there were no significant differences among the three
closed but unarousable to mild physical stimulation
groups.
[10].
For shivering, there was no significant difference
Rescue i.v. bolus doses of 9-mg ephedrine were
regarding the total number of patients who had
given if the patient became hypotensive
episodes of shivering between the three groups,
(hypotension was defined as a decrease in MAP of
where three (15%) of 20 patients in group G stated
>20% from the baseline). Decrease in HR to less than
having shivering: one patient had grade 2 shivering,
50 beat/min was treated with i.v. 0.5 mg atropine.
one patient had grade 3 shivering, and 1 patient had
Rescue i.v. 10 mg metoclopramide was given for
grade 4 shivering; in group K, three (15%) of 20
vomiting episodes. Persistent pain sensation or
patients, one patient had grade 2 shivering and two
movement of lower half was considered a failed
spinal anesthesia treatment, and the patients
underwent general anesthesia and were excluded Table 1 Bromage scale for grading of motor block
from the study. Grades Criteria Degree of
block

The height of sensory blockade was assessed as the I Free movement of legs and feet Nil (0)
highest dermatome with loss of fine pinprick sensation II Just able to flex knees with free Partial (33)
movement of feet
at two consecutive times. The time to two-segment III Unable to flex knees, but with free Almost
regression and sensory regression to T10 and S1 were movement of feet complete (66)
recorded and analyzed. The Bromage scale (Table 1) IV Unable to move legs or feet Complete
was used to evaluate motor block [11]. (100)
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Granisetron, ketamine, and pethidine for prevention of shivering Sayed 179

patients had grade 3 shivering; and lastly in group P 3/
20 (15%): 2 patients had grade 2 shivering and one
patient had grade 3 shivering. No patients in any of the
three groups had grade 4 shivering (Table 3 and Fig. 1).
Regarding sedation, all patients of group G had grade
one on sedation scale, whereas all patients of group P
had grade 2 on sedation scale, but in group K, 50% of
patient had grade 3 and 50% had grade 4.
Regarding the maximum cephalad spread of sensory
block, there were no significant differences.
At 60 min intraoperatively, there was significant
regression in sensory block in group G, which was
Figure 1
faster than both groups K and P, with P value of less
than 0.001 (Table 4).
At 2:00 and 4:00 h postoperatively, there was
significant regression in sensory block in group G,
which was faster than both groups K and P, with P
value of less than 0.001 (Table 5).
Also, regression to T10, and S1 were faster in group G
thangroups K and P, P value between groups K and P
(Table 6).
However, there was no significant difference between
groups K and P regarding sensory regression.
Regarding motor block, there were no significant
differences among the three groups in the time to
maximum motor block and the time to complete
motor recovery.

Regarding nausea, there were significant decrease of

incidence of nausea in group G compared with both
groups K and P at 15 min and 30 min intraoperatively
and 2:00 h postoperative, with P values of 0.046, 0.042,
and 0.017, respectively (Table 7). However, there was
no significant difference between groups K and P
regarding nausea. Moreover, the total number of
patients in group G having nausea episodes is 3/20
Number of patients who had shivering episodes at 15, 30, 45, and 60 (15%) but in group K is 17/20 (85%) and group P is 16/
min. 20 (80%).

Table 2 Comparison between study groups regarding mean arterial blood pressure intraoperative at 5, 10, 15, and 60 min
Mean arterial blood pressure Group G Group K Group P One-way analysis of
(granisetron) (ketamine) (pethidine) variance
(N=20) (N=20) (N=20)
Mean SD Mean SD Mean SD F P value
Intraoperative monitoring (min)
5 75.20 6.75 75.65 7.22 68.45 6.54 3.564 0.035
10 74.80 7.67 73.40 7.10 67.05 7.04 6.445 0.003
15 71.95 7.75 72.10 7.17 65.05 7.94 5.557 0.006
60 75.80 7.73 74.25 8.12 69.75 7.13 3.357 0.042

Table 3 Number of patients who had shivering episodes at 15, 30, 45, and 60 min
Time Shivering episodes with Group G (granisetron) Group K (ketamine) Group P (pethidine) χ2 P-
grading (N=20) [n (%)] (N=20) [n (%)] (N=20) [n (%)] value
Intraoperative monitoring (min)
15 No 19 (95.00) 19 (95.00) 20 (100.00) 2.034 0.362
Yes 1 (5.00) (grade 2) 1 (5.00) (grade 2) 0 (0.00)
30 No 19 (95.00) 20 (100.00) 19 (95.00) 2.614 0.342
Yes 1 (5.00) (grade 4) 0 (0.00) 1 (5.00) (grade 2)
45 No 19 (95.00) 19 (95.00) 19 (95.00) 0.536 0.765
Yes 1 (5.00) (grade 3) 1 (grade 3) (5.00) 1 (5.00) (grade 2)
60 No 20 (100.00) 19 (95.00) 19 (95.00) 2.027 0.353
Yes 0 (0.00) 1 (5.00) (grade 3) 1 (5.00) (grade 3)
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180 Al-Azhar Assiut Medical Journal, Vol. 16 No. 2, April-June 2018

Regarding vomiting, there was significant decrease in
incidence of vomiting in group G compared with both
groups K and P at 30 min and 45 min intraoperatively,
and 2:00 h postoperatively, with P values of 0.003, 0.020,
and 0.002, respectively (Table 8). However, there was no
significant difference between groups K and P regarding
vomiting. Moreover, the total number of patient in
group G having vomiting episodes is 3/20 (15%) but
in group K is 17/20 (85%) and group P is 16/20 (80%).
A number of factors, including age, duration of
surgery, temperature of the operating room, type of
regional anesthesia (spinal or epidural), and infusion
solution, are risk factors for hypothermia and
shivering [13]. Opioid and nonopioid drugs are
often used to treat postoperative shivering, but they
have potential adverse effects, including hypotension,
hypertension, sedation, respiratory depression, nausea,
and vomiting [14].

Granisetron, which is 5-HT3 receptor antagonists, have

Discussion been used effectively to decrease postanesthetic shivering.
Postoperative shivering reportedly complicates The mechanism for 5-HT3 receptor antagonists is still
emergence from anesthesia in 5–60% of cases [12]. unclear but is thought to be related to inhibition of

Table 4 Level of sensory block at 60 min intraoperatively regarding study groups

Time Level of sensory Group G (granisetron) Group K (ketamine) (N=20) Group P (pethidine) (N=20) χ2 P-
(min) block (N=20) [n (%)] [n (%)] [n (%)] value
60 T4 0 (0.00) 9 (45.00) 7 (35.00)
T5 1 (5.00) 4 (20.00) 6 (30.00)
T6 7 (35.00) 7 (35.00) 7 (35.00) 35.83 <0.001
T7 6 (30.00) 0 (0.00) 0 (0.00)
T8 6 (30.00) 0 (0.00) 0 (0.00)

Table 5 Sensory block among study groups at 2:00 and 4:00 h postoperatively
Time Level of sensory Group G (granisetron) (N=20) Group K (ketamine) Group P (pethidine) χ2 P-
(h) block [n (%)] (N=20) [n (%)] (N=20) [n (%)] value
2:00 S1 18 (90.00) 0 (0.00) 0 (0.00)
T10 1 (5.00) 20 (100.00) 20 (100.00) 55.61 <0.001
T12 1 (5.00) 0 (0.00) 0 (0.00)
4:00 Full recovery 18 (90.00) 0 (0.00) 0 (0.00) 51.429 <0.001
S1 2 (10.00) 20 (100.00) 20 (100.00)

Table 6 Comparison between times of regression of sensory block among study groups.
Time to level of regression (min) Group G Group K Group P One-way analysis
(granisetron) (ketamine) (N=20) (pethidine) (N=20) of variance
(N=20)
Mean SD Mean SD Mean SD F P-value
T6 35.45 22.03 28.94 19.93 35.33 21.74 0.49 <0.05
T8 50.85 43.55 38.11 30.67 51.06 42.91 0.45 <0.05
T10 62.51 29.75 47.9 25.57 61.22 39.75 0.42 <0.05
S1 198.4 31.63 132.4 36.94 197.5 32.74 0.56 <0.05

Table 7 Nausea at 15 and 30 min (intraoperatively) and 2:00 h (postoperatively) among study groups
Time Nausea Group G (granisetron) (N=20) Group K (ketamine) (N=20) Group P (pethidine) (N=20) χ2 P-
episodes [n (%)] [n (%)] [n (%)] value
Intraoperative monitoring (min)
15 No 19 (95.00) 15 (75.00) 15 (75.00) 6.146 0.046
Yes 1 (5.00) 5 (25.00) 5 (25.00)
30 No 19 (95.00) 13 (65.00) 15 (75.00) 6.316 0.042
Yes 1 (5.00) 7 (35.00) 5 (25.00)
Postoperative monitoring (h)
02:00 No 19 (95.00) 15 (75.00) 14 (70.00) 8.077 0.017
Yes 1 (5.00) 5 (25.00) 6 (30.00)
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Granisetron, ketamine, and pethidine for prevention of shivering Sayed
Table 8 Vomiting at 30 and 45 min (intraoperatively) and 2:00 h (postoperatively) among study groups
Time Vomiting Group G (granisetron) (N=20)
episodes [n (%)]
Intraoperative monitoring (min)
30 No 19 (95.00)
Yes 1 (5.00)
45 No 19 (95.00)
Yes 1 (5.00)
Postoperative monitoring (h)
02:00 No 19 (95.00)
Yes 1 (5.00)
serotonin reuptake on the preoptic anterior hypothalamic
region [15].
Ketamine probably controls shivering by nonshivering
thermogenesis either influencing the hypothalamus
or by the beta adrenergic effect of norepinephrine
[16].
Pethidine has been shown to be one of the most
effective treatments to prevent postoperative
shivering. The antishivering effect of pethidine is
because of stimulation of kappa receptors and drug-
induced decrease in the shivering threshold [17].
On evaluating the occurrence of shivering, it was found
that prophylactic use of granisetron, ketamine, and
pethidine was effective in preventing shivering
during neuraxial anesthesia without causing any
untoward adverse effects.
These results are supported by the findings of Iqbal
et al. [18] in which prophylactic use of granisetron
(40 μg/kg) and pethidine (25 mg) i.v. was effective in
preventing postoperative shivering.
In present study, results were also similar to the
findings of Shakya et al. [19] who suggested that the
prophylactic administration of low-dose ketamine
0.25 mg/kg and ondansetron 4 mg produces
significant antishivering effect in comparison with
placebo in patients undergoing spinal anesthesia and
that ketamine 0.25 mg/kg is significantly more
effective than ondansetron (4 mg).
Abotaleb et al. [20] in a study compared between
dexmedetomidine and granisetron for the
management of postspinal shivering and found that
granisetron 2 mg effectively reduces postspinal
shivering without any major adverse effects.
Moreover, Kabade et al. [21] obtained that
prophylactic granisetron 40 μg/kg i.v. is as effective
as pethidine 0.4 mg/kg i.v. in preventing
perioperative shivering following spinal anesthesia
181
Group K (ketamine) (N=20) Group P (pethidine) (N=20) χ2 P
[n (%)] [n (%)] value
13 (65.00) 13 (65.00) 10.027 0.003
7 (35.00) 7 (35.00)
17 (85.00) 17 (85.00) 7.778 0.020
3 (15.00) 3 (15.00)
13 (65.00) 14 (70.00) 11.036 0.002
7 (35.00) 6 (30.00)
and also reduces the need of antiemetics.
Gangopadhyay et al. [22] concluded that ketamine
0.5 mg/kg, i.v. was effective in preventing shivering
under spinal anaesthesia.
Mahmood and Zweifler [23] reported that ketamine i.v.
0.5 mg/kg was effective in the treatment of shivering
after general and regional anesthesia. Moreover, it
provided sedation and analgesia. Although two (2/20)
patients in their study had hallucinations, none
of the patients in our study reported hallucinations.
Adam et al. [24] demonstrated that a 3-mg/kg
ketamine infusion after a 0.5-mg/kg bolus dose did
not cause hallucinations.
This finding corroborates well with the finding of Park
et al. [25] who reported incidence of postoperative
shivering was decreased with pethidine pretreatment
group.
In a similar study, no case of shivering was reported in
the pethidine group. In addition, the use of
prophylactic low-dose ketamine in shivering control
after anesthesia for tonsillectomy in children was more
effective than pethidine [16].
In another study, it was found that 0.5 mg/kg ketamine
was better than 0.3 mg ketamine; however, pethidine is
still the first and best choice [26].
Regarding hemodynamics, the important finding in
this study is that there is decrease in reduction in
mean blood pressure in the granisetron and
ketamine groups but there is a reduction in MAP in
pethidine group, with significant difference recorded.
Although nonsignificant differences in heart rate were
observed between the groups at any time of study
duration.
Eldaba and Amr [27] showed that administration of
1 mg of granisetron at 5 min before spinal anesthesia
can reduce significantly the incidence of hypotension in
these patients in comparison with placebo (normal
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182 Al-Azhar Assiut Medical Journal, Vol. 16 No. 2, April-June 2018
saline). Moreover, they also reported that the dosages
of ephedrine and atropine in the granisetron group
were significantly lower than those of the placebo
group.
Shrestha et al. [28] concluded that granisetron given
i.v. does not decrease the incidence of hypotension and
bradycardia following subarachnoid block in patients
undergoing lower abdominal surgery. However, it
attenuates the fall of diastolic and MAP spinal
anesthesia.
In contrast, Jabalameli et al. [29] concluded that the
most effective method for prevention of hypotension
was administration of crystalloid preload plus
ephedrine, but there was no significant effect on the
severity of nausea.
Regarding motor and sensory block, one of the most
important finding in this study is that i.v. granisetron
administration before spinal bupivacaine results in a
faster recovery of the sensory blockade. On the
contrary, the offset of motor blockade was similar in
all groups.
Granisetron strongly and selectively binds to the 5-
HT3 receptors with minimal or no affinity for other 5-
HT receptors, or dopaminergic, adrenergic,
histaminic, and opioid receptors [30]. Additionally,
it has minimal adverse effects and possible drug
interactions [31].These findings are in agreement
with prior studies by Khalifa [32], Mowafi et al.
[33], and Rashad and Farmawy [34], who concluded
that i.v. granisetron facilitated the recovery of
sensory block after bupivacaine subarachnoid
anesthesia.
Kasem [35] found that administration of 1 mg of
granisetron before spinal anesthesia in ambulatory
surgeries resulted in a statistically faster sensory
regression and earlier home discharge from the day-
surgery unit.
Nausea and vomiting are common and sometimes
dangerous adverse effects following surgery. Most of
the incidences of nausea and vomiting occur during the
first 2 h of recovery from anesthesia. The etiology of
postoperative nausea and vomiting is multifactorial
[36].
Janelsins et al. [37] in their study to prevent nausea and
vomiting following cancer chemotherapy concluded
that both ondansetron and granisetron have similar
antiemetic efficacy, but dose of granisetron is much less
than ondansetron.
Makker et al. [38] concluded that in the early
postoperative period both ondansetron and
granisetron are equally effective in preventing
postoperative nausea and vomiting in patients
undergoing gynecological surgery under spinal
anesthesia.
Conclusion
In patients undergoing lower half surgery under spinal
anesthesia, prophylactic i.v. administration of 3 mg
granisetron, 25 mg ketamine or 25 mg pethidine
5 min before induction of spinal anesthesia
significantly reduces the severity of postanesthetic
shivering without significant difference between the
three drugs.
Granisetron reduces the incidence of nausea and
vomiting and because of its hemodynamic stability,
lack of significant adverse effects, and better patient
satisfaction, it is preferred over other antiemetic and
antishivering drugs.
Another finding regarding sensory block showed a
significant faster recovery of sensory block with
granisetron compared with both ketamine and
pethidine groups, with no significant differences
between the latter two groups, so granisetron may be
useful in day case surgery and faster departure of
patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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