Prophylaxis of intra- and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia

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. Spinal anesthesia was performed in left prone position, at L3/L4 wit...

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Bibliographic Details
Published in:	Medical science monitor Vol. 19; pp. 993 - 1000
Main Authors:	Voigt, Matthias, Fröhlich, Christian W, Hüttel, Christiane, Kranke, Peter, Mennen, Jan, Boessneck, Oliver, Lenz, Christian, Erbes, Thalia, Ernst, Jürgen, Kerger, Heinz
Format:	Journal Article
Language:	English
Published:	United States International Scientific Literature, Inc 14-11-2013
Subjects:	Anesthesia, Spinal - adverse effects Antiemetics - pharmacology Cesarean Section - methods Dexamethasone - pharmacology Dimenhydrinate - pharmacology Female Humans Indoles - pharmacology Intraoperative Complications - prevention & control Metoclopramide - pharmacology Postoperative Nausea and Vomiting - prevention & control Product Investigations Prospective Studies Regression Analysis Time Factors
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Summary:	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. 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. 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. 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.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23 Funds Collection Data Interpretation Literature Search Data Collection Study Design Manuscript Preparation Statistical Analysis
ISSN:	1643-3750 1234-1010 1643-3750
DOI:	10.12659/MSM.889597