Comparative evaluation of preventive potentials of intravenous hydrocortisone and ondansetron on post-spinal anesthesia hypotension in elective surgeries: a randomized controlled double-blinded trial

Background: Spinal anesthesia (SA) is a mainstay of regional anesthesia, which provides favorable effective level of anesthesia and analgesia during surgeries. However, post-spinal anesthesia hypotension (PSAH) remains a persistent troublesome complication.Aim: This study was designed to test the prophylactic effect of Hydrocortisone versus Ondansetron and control, on the incidence and onset of PSAH.Methods: 120 elective surgical patients scheduled to receive spinal anesthesia were randomized into three groups: Group H, Group O, Group C, which received 100mg Hydrocortisone, 8 mg Ondansetron, and placebo respectively. The intervention was carried out 15 min before spinal anesthesia. The outcomes included the incidence of PSAH (SBP < 90 mmHg or a 20% drop from baseline), and time to PSAH if occurred.Results: Group H demonstrated a statistically significant lower incidence of hypotension (25%) compared to Group O (52.5%) and Group C (65%) with P=0.001. Furthermore, Hydrocortisone uniquely provided a statistically significant delay in the onset of hypotension (21.5+8.8 min) compared to Control (13.7+6.4 min) with P=0.03. There was no significant difference between group H and group O, or group O and group C regarding the onset of hypotension. No statistically significant difference was demonstrated regarding bradycardia or atropine administration between groups.Conclusion: Prophylactic intravenous Hydrocortisone proved superior to Ondansetron and control in preventing the overall incidence of post-spinal hypotension and significantly delaying its onset. So, we propose that hydrocortisone may serve as a valuable and effective option for enhancing hemodynamic stability in patients receiving spinal anesthesia.