Prophylaxis of intra- and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia
Matthias Voigt, Christian W. Fröhlich, Christiane Hüttel, Peter Kranke, Jan Mennen, Oliver Boessneck, Christian Lenz, Thalia Erbes, Jürgen Ernst, Heinz Kerger
Evangelian Deaconry Hospital, Freiburg, Germany
Med Sci Monit 2013; 19:993-1000
This paper describes a randomized prospective study conducted in 308 patients undergoing caesarean section in spinal anaesthesia at a single hospital between 2010 and 2012 to find a suitable anti-emetic strategy for these patients.
Material and Methods: Spinal anesthesia was performed in left prone position, at L3/L4 with hyperbaric 0.5% Bupivacaine according to a cc/cm body height ratio. There were no opioids given peri-operatively. The patients received either no prophylaxis (Group I) or tropisetron and metoclopramide (Group II) or dimenhydrinate and dexamethasone (Group III), or tropisetron as a single medication (Group IV). The primary outcome was nausea and/or vomiting (NV) in the intraoperative, early (0–2 h) or late (2–24 h) postoperative period.
Multivariate statistical analysis was conducted with a regression analysis and a backward elimination of factors without significant correlation.
Results: All prophylactic agents significantly reduced NV incidence intraoperatively. Relative risk reduction for NV by prophylaxis was most effective (59.5%) in Group II (tropisetron and metoclopramide). In Group III (dimenhydrinate and dexamethasone), NV risk was reduced by 29.9% and by 28.7% in Group IV (tropisetron mono-therapy). The incidence of NV in the early (0–2 h) and the late (2–24 h) postoperative period was low all over (7.8%), but the relative risk reduction of NV in the early postoperative period was 54.1% (Group IV), 45.1% (Group III), and 34.8% (Group II), respectively. In the late postoperative period, there was no significant difference between the 4 groups.
Conclusions: We recommend a prophylactic medication with tropisetron 2 mg and metoclopramide 20 mg for patients during caesarean section. These agents are safe, reasonably priced, and highly efficient in preventing nausea and vomiting.
Keywords: Cesarean Section - methods, Antiemetics - pharmacology, Anesthesia, Spinal - adverse effects, Dexamethasone - pharmacology, Dimenhydrinate - pharmacology, Indoles - pharmacology, Intraoperative Complications - prevention & control, Metoclopramide - pharmacology, Postoperative Nausea and Vomiting - prevention & control, Prospective Studies, Regression Analysis, Time Factors