Effectiveness of Intravenous Metoclopramide Prophylaxis on the Reduction of Intraoperative and Early Postoperative Nausea and Vomiting after Emergency Caesarean Section under Spinal Anaesthesia (original) (raw)
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The Journal of Obstetrics and Gynecology of India, 2015
Background The purpose of this study was to assess the efficacy and outcomes of preoperative prophylactic metoclopramide and dimenhydrinate use in elective cesarean births. Methods Participants (n = 84) scheduled for elective cesarean births were randomized equally into placebo (10 cc 0.9 % NaCl), 10-mg metoclopramide or 50-mg dimenhydrinate groups. Oral alimentation was prohibited 8 h before the surgery; however, patients continued drinking water until 4 h before surgery. Placebo and antiemetics were administered 1 h before the anticipated procedure in a 5-ml syringe. In metoclopramide and dimenhydrinate group, an ampoule of the agents was completed to 5 ml by adding 0.9 % NaCl. In the control group 5 ml of 0.9 % NaCl was used. All prophylactic agents were administered intramuscularly. All patients received a general anesthesia. The placebo group (control group) was compared with the metoclopramide and dimenhydrinate groups. Results Demographic data including maternal age, height, weight, body mass index, gravidity, parity, miscarriage, induced abortion, the number of offspring, and the medical history did not show significant differences among the three groups. Postoperative nausea, vomiting, and the use of rescue medication ratios were significantly lower in metoclopramide and dimenhydrinate groups compared with the placebo group (p \ 0.05); however, the difference Previous Presentation A brief summary of the study was presented in '
Journal of Evolution of medical and Dental Sciences, 2015
To evaluate the anti-emetic efficacy of bolus doses of metoclopramide and ondansetron in preventing nausea and vomiting in caesarean section under spinal anaesthesia. METHODS: Sixty patients of ASA-Ī and ĪĪ undergoing elective caesarean section were randomly divided into 2 groups of 30 each. Group A (n=30) received IV metoclopramide 10mg and Group B (n=30) received IV ondansetron 4mg, 30 minutes prior to spinal anaesthesia. Anaesthetic management was standardized and incidence of nausea, retching and vomiting was compared between the two groups. RESULTS: The maternal characteristics regarding age, weight and gestational period were not significantly different between the two groups. There was also no statistically significant (p>0.05) difference of anti-emetic effects (Nausea, vomiting) between the two studied drugs. CONCLUSION: No single intervention is available to completely eliminate nausea and vomiting. Metoclopramide is as effective as ondansetron in preventing the incidence of nausea and vomiting in caesarean delivery under spinal anaesthesia.
National Journal of Community Medicine, 2011
Objective: To compare the combined effect of two traditional antiemetic drugs (metoclopramide and glycopyrrolate) against published data of effect of single antiemetic drug for prevention of nausea and vomiting in women undergoing lower section caesarean section under spinal anaesthesia Methods: Seventy eight full term parturient women undergoing lower segment cesarean section under spinal anesthesia(using 5% lignocaine) were injected metoclopramide 10mg & glycopyrrolate 0.2mg intravenously at the time of abdominal incision. The frequency of nausea and vomiting and Apgar scores of neonates were noted. Results: Incidence of nausea was noted in 3.84% during operative and post operative period. No incidence of vomiting and any other adverse effects were observed. Apgar scores were >8 in all neonates at one and five minutes. Conclusion: Incidence of vomiting is low (zero case) in current study group compared to groups(data from published research) with either metoclopramide or glycopyrrolate or ondansetron but observed differences are statistically insignificant, however the upper class interval limit of Z value falling above significance level (>1.96) in all groups suggesting that it might significant and required further studies to prove or disprove significantly lower incidences of nausea and vomiting if combine use of two drugs (glycopyrrolate plus metoclopramide) as a prophylactic antiemetic in elective cesarean section under spinal anesthesia.
Background: Nausea and/or vomiting following regional anaesthesia in pregnant females undergoing caesarean section is a major clinical problem. This study was conducted to compared the efficacy of metoclopramide, dexamethasone, and their combination for preventing intra operative & post-operative nausea and vomiting (PONV) following spinal anaesthesia given for caesarean section in patients. Materials and Methods: A total of 120 full term pregnant females of ASA I & II grade with uncomplicated pregnancies were included in this prospective randomized double blind study. Patients were randomly allocated to three groups. The group D (n= 40) received 8 mg dexamethasone, group M (n=40) received10 mg of metoclopramide while group D+M (n= 40) received 8 mg dexamethasone along with10 mg of metoclopramide intravenously immediately before administration of spinal anaesthesia. Intraoperative and post operative emetic episodes (nausea, retching, and vomiting) was noted as well as any other adverse effects. Results: During intraoperative period all parturients had PONV score 0. Postoperatively at first hour number of full responders in group D, M and D+M were 29/40 (72.5%), 30/40 (75%), 38/40 (95%) and the difference was statistically significant (Group D Vs Group D+ M, P value-0.013 and Group M Vs Group D+ M, P value-0.025). At 3rd hour postoperatively 9 patients in Group D, 8 patients in Group M and 1 in Group D+ M, had PONV score 1 (Group D Vs Group D+ M, P value-0.014 and Group M Vs Group D+ M, P value-0.029). No patient had any vomiting episodes over the time period of 24 hrs. Anesthesia and Critical Care 2 Conclusion: Combined use of dexamethasone and metoclopramide as a prophylactic antiemetic was significantly better for the prevention of PONV as compared to the use of dexamethasone and metoclopramide alone.
British Journal of Anaesthesia, 2012
† The use of metoclopramide has declined in many surgical settings. † The use of metoclopramide 10 mg for prophylaxis against intra-and postoperative nausea and vomiting associated with Caesarean section is analysed. † Metoclopramide was effective in this group of patients. † The role of this inexpensive drug may be worthy of re-evaluation. Summary. Nausea and vomiting occur commonly during and after Caesarean delivery (CD) performed under neuraxial anaesthesia. Metoclopramide is a prokinetic agent reported to be safe in parturients. This meta-analysis assesses the efficacy of metoclopramide for prophylaxis against intra-and postoperative nausea and vomiting (IONV and PONV) in parturients undergoing CD under neuraxial anaesthesia. We performed a literature search of MEDLINE (1966-2011), Cochrane Central Register of Controlled Trials, EMBASE (1947-2011), Google scholar, and CINAHL for randomized controlled trials which compared metoclopramide with placebo in women having CD under neuraxial anaesthesia. Eleven studies with 702 patients were included in the analysis. Administration of metoclopramide (10 mg) resulted in a significant reduction in the incidence of ION and IOV when given before block placement [relative risk (RR) (95% confidence interval, 95% CI)¼0.27 (0.16, 0.45) and 0.14 (0.03, 0.56), respectively] or after delivery [RR (95% CI)¼0.38 (0.20, 0.75) and 0.34 (0.18, 0.66), respectively]. The incidence of early (0-3 or 0-4 h) PON and POV [RR (95% CI)¼0.47 (0.26, 0.87) and 0.45 (0.21, 0.93), respectively] and overall (0-24 or 3-24 h) PON (RR 0.69; 95% CI 0.52, 0.92) were also reduced with metoclopramide. Extra-pyramidal side-effects were not reported in any patient. In conclusion, this review suggests that metoclopramide is effective and safe for IONV and PONV prophylaxis in this patient population. Given the quality of the studies and the infrequent use of neuraxial opioids, these results should be interpreted with caution in current practice and further studies are needed to confirm those findings.
Biomedical Research (Aligarh), 2018
Background: Nausea and vomiting, after pain, is the most common adverse effect of cesarean section, such that it is reported in more than 66% of the patients undergoing cesarean section delivery under spinal anesthesia. There are several treatment choices for this problem, including injection of metoclopramide and ondansetron. This study aimed to compare the antiemetic efficacy of these two medications. Methods: This double-blind, interventional study was conducted on 120 women undergoing cesarean section at Amir-Al Momenin Hospital, Zabol, Iran. The patients were randomly assigned to metoclopramide (10 mg) and ondansetron (4 mg) groups. The rate of nausea and vomiting was assessed in both groups immediately after cesarean section and every 6 h until 24 h after the operation. To analyze the data, Chi-squared test, McNemar's test, paired t-test, and Wilcoxon signed-rank test were run, using SPSS version 21 software. Results: In total, the mean age of the participants was 30.41 ± 8.22 y. The frequency rates of nausea and vomiting in the ondansetron group at 0, 6, 12, and 24 hours after the operation were 36.7%, 35.0%, 16.7%, 3.3% respectively. The corresponding figures for metoclopramide group were 28.3%, 21.7%, 18.3%, and 10.0% respectively. Conclusion: Our study showed that ondansetron does not have any superiority to metoclopramide in terms of reducing post-cesarean nausea/vomiting. To confirm our results, further longitudinal studies with larger sample sizes are recommended.
Bimonthly Journal of Hormozgan University of Medical Sciences, 2016
Introduction: Nausea and vomiting is one of the complications of spinal anesthesia in cesarean section. The aim of this study was to compare the effects of dexamethasone-metocloprmide with ondansetrone on preventing nausea and vomiting during spinal Anesthesia for cesarean section. Methods: In this study 212 pregnant women (17-45 years old) candidate for elective cesarean section with an ASA I-II were subjected to a randomized double blind clinical trial. Before spinal anesthesia was applied the first group received 8 milligram dexamethasone and 10 milligram metoclopramide intravenously, the second group received 8 milligram ondansetrone intravenously. Correspondence: Saeed Kashani, MD. Anesthesiology Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran Tel:+98 9177614110 Email: sdkashani468@gmail.com Results: There were no significant differences between the two groups regarding the demographic variables, and also heart rat...
Journal of clinical anesthesia, 2001
Study Objective: To compare the relative efficacy of prophylactic metoclopramide, ondansetron, and placebo in nonemergent cesarean section patients given epidural anesthesia intraoperatively and for the first 24-hour period after delivery. Design: Randomized, double blind, placebo-controlled study. Setting: Inpatient obstetric unit at a university hospital center. Patients: 164 nonemergent cesarean section patients given epidural anesthesia. Intervention: At time of umbilical cord clamp, patients received intravenously (IV) either 4 mg ondansetron (Group O) or 10 mg metoclopramide (Group M) or 10 mL normal saline (Group P). Measurements and Main Results: Episodes and severity of nausea and vomiting, rescue antiemetic requirement, patient satisfaction, and side effects were recorded. The frequency of intraoperative nausea were 24%, 43%, and 57% for Group O, Group M, and Group P, respectively (p Ͻ 0.03). The frequency of nausea for the 24-hour study period were 26%, 51% and 71% for Groups O, M, and P respectively (p Ͻ 0.03). The frequency of intraoperative and postoperative vomiting were similar between Group O and Group M, but significantly higher in Group P (p Ͻ 0.05). Overall patient satisfaction was highest in Group O compared with Groups P and M (p Ͻ 0.05). Maximum analog sedation score was higher in Group M compared to Groups O and P (p Ͻ 0.05). Conclusions: In cesarean section patients given epidural anesthesia, prophylactic ondansetron, 4 mg IV, is more efficacious and has a higher patient satisfaction than that with metoclopramide, 10 mg IV, or placebo in preventing nausea and achieving complete responses during intraoperative period and the first 24-hour postdelivery period. However, there is no difference between ondansetron and metoclopramide in reducing frequency of vomiting. Prophylactic ondansetron 4 mg IV is more effective in preventing nausea than vomiting.
Journal of Clinical Anesthesia, 2001
Study Objective: To compare the relative efficacy of prophylactic metoclopramide, ondansetron, and placebo in nonemergent cesarean section patients given epidural anesthesia intraoperatively and for the first 24-hour period after delivery. Design: Randomized, double blind, placebo-controlled study. Setting: Inpatient obstetric unit at a university hospital center. Patients: 164 nonemergent cesarean section patients given epidural anesthesia. Intervention: At time of umbilical cord clamp, patients received intravenously (IV) either 4 mg ondansetron (Group O) or 10 mg metoclopramide (Group M) or 10 mL normal saline (Group P). Measurements and Main Results: Episodes and severity of nausea and vomiting, rescue antiemetic requirement, patient satisfaction, and side effects were recorded. The frequency of intraoperative nausea were 24%, 43%, and 57% for Group O, Group M, and Group P, respectively (p Ͻ 0.03). The frequency of nausea for the 24-hour study period were 26%, 51% and 71% for Groups O, M, and P respectively (p Ͻ 0.03). The frequency of intraoperative and postoperative vomiting were similar between Group O and Group M, but significantly higher in Group P (p Ͻ 0.05). Overall patient satisfaction was highest in Group O compared with Groups P and M (p Ͻ 0.05). Maximum analog sedation score was higher in Group M compared to Groups O and P (p Ͻ 0.05). Conclusions: In cesarean section patients given epidural anesthesia, prophylactic ondansetron, 4 mg IV, is more efficacious and has a higher patient satisfaction than that with metoclopramide, 10 mg IV, or placebo in preventing nausea and achieving complete responses during intraoperative period and the first 24-hour postdelivery period. However, there is no difference between ondansetron and metoclopramide in reducing frequency of vomiting. Prophylactic ondansetron 4 mg IV is more effective in preventing nausea than vomiting.