Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo.

Abstract

BACKGROUND:

Low-dose intrathecal (spinal) morphine (0.1-0.2 mg) for Caesarean section delivers excellent postoperative analgesia but is associated with significant nausea and vomiting. We compared the antiemetic efficacy of cyclizine, dexamethasone, and placebo in this clinical setting.

METHODS:

Ninety-nine women undergoing elective Caesarean section under spinal anaesthesia were allocated randomly, in a double-blind study design, to receive either cyclizine 50 mg, dexamethasone 8 mg, or placebo as a single-dose infusion in saline 0.9%, 100 ml on completion of surgery. Spinal anaesthesia consisted of: hyperbaric bupivacaine 0.5%, 2.0 ml; fentanyl 10 micro g; and spinal morphine 0.2 mg. The primary outcome measure was the incidence of nausea.

RESULTS:

The incidence of nausea was significantly less in patients receiving cyclizine compared with dexamethasone and placebo (33 vs 60 and 67%, respectively, P<0.05). Severity of nausea and number of vomiting episodes were also less at 3-6 h in cyclizine patients. Overall satisfaction with postoperative care at 24 h, expressed on a 100 mm visual analogue scale, was greater in cyclizine [78 (28)] than either dexamethasone [58 (31), P=0.03] or placebo [51 (28), P=0.008].

CONCLUSION:

We conclude that following spinal morphine 0.2 mg and fentanyl 10 micro g analgesia for Caesarean section, cyclizine 50 mg i.v. reduces the incidence of nausea compared with dexamethasone 8 mg i.v. or placebo. It also lessens the severity of nausea and vomiting, and increases maternal satisfaction in the early postoperative period.

• Authors: S-A Nortcliffe, J Shah, D J Buggy
• Journal: British journal of anaesthesia (Br J Anaesth) Vol. 90 Issue 5 Pg. 665-70 (May 2003) ISSN: 0007-0912 [Print] England
• PMID: 12697596 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Analgesics, Opioid
• Antiemetics
• Morphine
• Dexamethasone
• Cyclizine

Topics

• Adult
• Analgesia, Obstetrical (adverse effects)
• Analgesics, Opioid (adverse effects)
• Anesthesia, Obstetrical
• Anesthesia, Spinal
• Antiemetics (therapeutic use)
• Cesarean Section
• Cyclizine (therapeutic use)
• Dexamethasone (therapeutic use)
• Double-Blind Method
• Female
• Humans
• Morphine (adverse effects)
• Patient Satisfaction
• Postoperative Nausea and Vomiting (chemically induced, prevention & control)
• Pregnancy
• Severity of Illness Index