Effect of granisetron on the spinal anesthesia-induced hemodynamic changes: a meta-analysis of randomized controlled trials
In brief
Granisetron halves hypotension risk and cuts vasopressor use in spinal anesthesia
A meta-analysis of 14 randomized trials (1,388 patients) found that intravenous granisetron reduced the incidence of spinal-anesthesia-induced hypotension by about 50% and lowered the need for vasopressors. It also lessened shivering and improved early blood pressure in non-obstetric surgeries, but high study heterogeneity and possible publication bias mean larger trials are needed.
- Journal
- Journal of anesthesia (Q2)
- Published
- 8 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Bon-Wook Koo, Hyo-Seok Na, Hyun-Jung Shin
- PMID
- 42570099
- DOI
- 10.1007/s00540-026-03864-z
Why clinicians should know about it
- Picked for Physiology (medical) (top studies of the week, 9 August 2026).
Abstract
BACKGROUND: Spinal anesthesia induces hemodynamic disturbances such as hypotension and bradycardia. Granisetron, a 5-HT₃ receptor antagonist primarily used for antiemesis, has been proposed to mitigate these effects. METHODS: This meta-analysis of randomized controlled trials evaluated intravenous granisetron versus placebo/no treatment in adults undergoing elective surgery under spinal anesthesia, reporting hypotension (primary outcome), bradycardia, shivering, hemodynamic changes, and vasopressor use. A random-effects model was used to calculate relative risks (RR) or mean differences (MD) with 95% confidence intervals (CI), with subgroup analysis by surgical type (cesarean vs. nonobstetric). RESULTS: Fourteen trials (n = 1388) were included. Granisetron significantly reduced overall hypotension (RR = 0.51; p < 0.001), vasopressor use (RR = 0.64; p = 0.008), and shivering (RR = 0.32; p < 0.001). Bradycardia reduction was significant only in nonobstetric participants (RR = 0.48; p = 0.047), not overall (p = 0.118); similarly, mean arterial pressure (MAP) at 5 and 15 min (p = 0.001, p < 0.001) and heart rate at 5 min (p = 0.013) improved only in nonobstetric surgery, with no overall significance. Heterogeneity was substantial for most continuous outcomes (I2 > 85%). Funnel plot asymmetry suggested possible publication bias/small-study effects for hypotension and MAP at 30 min, with no major concern for other outcomes. CONCLUSIONS: Granisetron appears effective in reducing hypotension, vasopressor use, and shivering during spinal anesthesia, with early hemodynamic benefits in nonobstetric surgery. Given the heterogeneity and publication bias identified, findings warrant cautious interpretation requiring larger trials. TRIAL REGISTRATION: PROSPERO, CRD420251034777. Registered 17 April 2025, https://www.crd.york.ac.uk/prospero/.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.