Prophylactic Intravenous Ondansetron for Hemodynamic Stability and Shivering Prevention in Elective Cesarean Section under Spinal Anesthesia: Review Article

Background: Due to sympathetic blocking and aortocaval compression by the gravid uterus, spinal anesthesia (SA) during elective Cesarean section (CS) typically causes substantial hypotension and bradycardia, which commonly causes mother pain and fetal impairment. Hemodynamic instability and oxygen demand are further worse by concurrent postoperative shivering. Because traditional preventative measures are still ineffective, research into alternative pharmaceutical therapies to improve maternal hemodynamic stability and comfort is being conducted.
Objective: This review aimed toassess the efficacy of prophylactic IV ondansetron in preventing SA–induced hypotension, bradycardia, and shivering in adult patients undergoing elective CS.
Methods: From 2020 to 2025, a thorough search was carried out in PubMed, Google Scholar, and Science Direct using the following keywords: Ondansetron, SA, Hypotension, Bradycardia, Shivering and Elective CS. The reviewers also assessed the references to pertinent literature.  Only the most recent or comprehensive study was considered. Oral presentations, dissertations, conference abstracts, and unpublished papers are a few examples of works that weren't considered important scientific study. Documents published in languages other than English were ignored as a result of lack of translation resources.
Conclusions: Prophylactic IV ondansetron demonstrated high efficacy for reducing the incidence of SA–induced hypotension, bradycardia, and postoperative shivering, significantly lowering vasopressor requirements. Its rapid onset, favorable maternal and fetal safety profile, and accessibility made it a valuable adjunct for enhancing perioperative hemodynamic stability and patient comfort during Cesarean delivery. Further large-scale trials are warranted to standardize dosing and administration protocols.