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Abstract

Introduction: Spinal anesthesia (SA) is widely used for lower abdominal and limb surgeries due to its rapid onset and favorable safety profile. However, because of sympathetic blockade, it frequently results in bradycardia and hypotension, increasing the risk of perioperative complications and postoperative nausea and vomiting (PONV). Intrathecal atropine has shown potential as an adjuvant to counteract these effects and improve anesthesia outcomes. This review evaluates current evidence on the safety and efficacy of intrathecal atropine in SA.
Methods: MEDLINE, EMBASE, CENTRAL, Scopus, ProQuest, and Google Scholar were searched for randomized controlled trials published in English up to April 2025 on intrathecal atropine as an adjuvant in SA. The primary outcome was PONV; secondary outcomes included sensory block onset, postoperative pain, and adverse effects. Risk of bias was assessed using the Cochrane RoB 2.0 tool.
Results: Five RCTs involving 584 patients were included. Intrathecal atropine significantly reduced the incidence and severity of PONV in most studies (P < 0.05). However, it did not show significant effects on postoperative pain scores, sensory block onset, or hemodynamic parameters compared to control or other adjuvants. Adverse effects were generally mild and comparable across groups, though one study reported a higher incidence of pruritus with atropine (P < 0.001). No serious complications were observed. Nonetheless, study limitations included small sample sizes, non-standardized outcomes, and single-center designs with limited follow-up.
Conclusions: Intrathecal atropine may reduce PONV after SA without serious adverse effects. However, its impact on pain, sensory block, and hemodynamics remains uncertain, warranting further large-scale, standardized trials.
Abbreviations: GA: general anesthesia, RCT: randomized controlled trial, SA: Spinal anesthesia, PONV: postoperative nausea and vomiting
Keywords: Adjuvant; Atropine; Complications; Intrathecal; Outcome; PONV; Postoperative Nausea and Vomiting; Spinal Anesthesia
Citation: Pramadika T, Mochamat, Nurcahyo WI, Wicaksono SA, Saputra T, Manapa CH, Ksatriaputra A. Intrathecal atropine as an adjuvant in spinal anesthesia: a systematic review of efficacy and safety. Anaesth. pain intensive care 2025;29(7):796-807. DOI: 10.35975/apic.v29i7.2947