Comparison of the Prophylactic Effect of Propofol, Dexamethasone and Ondansetron on Post-Operative Nausea and Vomiting in Elective Cesarean Section Under Spinal Anesthesia
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Abstract
Nausea and vomiting are common complications in women undergoing cesarean section with spinal anesthesia. This study aimed to compare the propofol, dexamethasone, and ondansetron effects on nausea and vomiting. In this double-blind randomized clinical trial study, 120 women aged 15 to 35 years candidates for cesarean section under spinal anesthesia were enrolled. Patients were randomly divided into four groups (three-drug groups and the control group). Patients received 0.05 mg /kg ondansetron (group O), 0.1 mg /kg dexamethasone (group D), 0.2 mg/kg propofol (group P) and normal saline in controls (group C). Nausea and vomiting in recovery and 6 hours after surgery compared between groups. In recovery and 6 hours after surgery, both nausea and vomiting were the highest in group C while they were lowest in group O. the frequency of nausea was 11(36.7%) in both recovery and 6 hours after surgery and the frequency of vomiting was 12(40%) and 10(33.3%) in the recovery and 6 hours after surgery respectively. Among the three drug groups, nausea and vomiting were higher in group D in both recovery rooms and 6 hours after surgery. The frequency of vomiting was 10 (33.3%) and 5 (16.7%) in recovery and 6 hours after surgery in group D respectively. these differences were statistically significant between the four groups (p<0.05). The preventive effect of dexamethasone is not very useful in both periods. Therefore, it can be recommended that in the short period after surgery, propofol has a beneficial effect in preventing postoperative nausea and vomiting.
1. Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth 2002; 89:409-23.
2. Eberhart LH, Högel J, Seeling W, Staack AM, Geldner G, Georgieff M. Evaluation of three risk scores to predict postoperative nausea and vomiting. Acta Anaesthesiol Scand 2000; 44:480-8.
3. Darkow T, Gora-Harper ML, Goulson DT, Record KE. Impact of antiemetic selection on postoperative nausea and vomiting and patient satisfaction. Pharmacotherapy 2001; 21:540-8.
4. Schumann R, Polaner DM. Massive subcutaneous emphysema and sudden airway compromise after postoperative vomiting. Anesth Analg. 1999; 89:796-7.
5. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004; 350:2441-51.
6. Lussos SA, Bader AM, Thornhill ML, Datta S. The antiemetic efficacy and safety of prophylactic metoclopramide for elective cesarean delivery during spinal anesthesia. Reg Anesth 1992; 17:126-30.
7. Santos A, Datta S. Prophylactic use of droperidol for control of nausea and vomiting during spinal anesthesia for cesarean section. Anesth Analg 1984; 63:85-7.
8. Harmon D, Ryan M, Kelly A, Bowen M. Acupressure and prevention of nausea and vomiting during and after spinal anesthesia for caesarean section. Br J Anaesth 2000; 84:463-7.
9. Crocker JS, Vandam LD. concerning nausea and vomiting during spinal anesthesia. Anesthesiology 1959; 20:587-92.
10. Ratra CK, Badola RP, Bhargava KP. A study of factors concerned in emesis during spinal anaesthesia. Br J Anaesth 1972; 44:1208-11.
11. Balki M, Carvalho JC. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. Int J Obstet Anesth 2005; 14:230-41.
12. Pan PH, Moore CH. Intraoperative antiemetic efficacy of prophylactic ondansetron versus droperidol for cesarean section patients under epidural anesthesia. Anesth Analg 1996; 83:982-6.
13. Balki M, Kasodekar S, Dhumne S, Carvalho JC. Prophylactic granisetron does not prevent postdelivery nausea and vomiting during elective cesarean delivery under spinal anesthesia. Anesth Analg 2007; 104:679-83.
14. Pan PH, Moore CH. Comparing the efficacy of prophylactic metoclopramide, ondansetron, and placebo in cesarean section patients given epidural anesthesia. J Clin Anesth 2001; 13:430-5.
15. Hesketh PJ. Comparative review of 5-HT3 receptor antagonists in the treatment of acute chemotherapy-induced nausea and vomiting. Cancer Invest 2000; 18:163-73.
16. De Oliveira GS, Jr, Castro-Alves LJ, Ahmad S, Kendall MC, McCarthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: An updated meta-analysis of randomized controlled trials. Anesth Analg 2013; 116:58-74.
17. Leeser J, Lip H. Prevention of postoperative nausea and vomiting using ondansetron, a new, selective, 5-HT3 receptor antagonist. Anesth Analg 1991; 72:751-5.
18. Scuderi P, Wetchler B, Sung YF, Mingus M, DuPen S, Claybon L, et al. Treatment of postoperative nausea and vomiting after outpatient surgery with the 5-HT3 antagonist ondansetron. Anesthesiology 1993; 78:15-20.
19. Wang JJ, Ho ST, Lee SC, Liu YC, Liu YH, Liao YC. The prophylactic effect of dexamethasone on postoperative nausea and vomiting in women undergoing thyroidectomy: A comparison of droperidol with saline. Anesth Analg 1999; 89:200-3.
20. Tzeng JI, Wang JJ, Ho ST, Tang CS, Liu YC, Lee SC. Dexamethasone for prophylaxis of nausea and vomiting after epidural morphine for post-caesarean section analgesia: Comparison of droperidol and saline. Br J Anaesth 2000; 85:865-8.
21. Parrington SJ, O’Donnell D, Chan VW, Brown-Shreves D, Subramanyam R, Qu M, et al. Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade. Reg Anesth Pain Med 2010; 35:422-6.
22. Wattwil M, Thörn SE, Lövqvist A, Wattwil L, Gupta A, Liljegren G. Dexamethasone is as effective as ondansetron for the prevention of postoperative nausea and vomiting following breast surgery. Acta Anaesthesiol Scand 2003; 47:823-7.
23. Draisci G, Valente A, Suppa E, Frassanito L, Pinto R, Meo F, et al. Remifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial. Int J Obstet Anesth 2008; 17:130-6.
24. Marucci M, Diele C, Bruno F, Fiore T. Subarachnoid anaesthesia in caesarean delivery: effects on alertness. Minerva Anesthesiol 2003; 69:809-19.
25. Ryding EL, Wijma B, Wijma K. Posttraumatic stress reactions after emergency cesarean section. Acta Obstet Gynecol Scand 1997; 76:856-61.
26. Ramsay MA, Savege TM, Simpson BR. Controlled sedation with alphaxolone-alphadalone. Br Med J 1974; 2:656-9.
27. Patki A, Shelgaonkar VC. A Comparison of equisedative infusions of propofol and midazolam for conscious sedationduring spinal anesthesia - a prospective randomized study. J Anaesthesiol Clin Pharmacol 2011; 27:47-53.
28. Kovac AL. Prevention and treatment of postoperative nausea and vomiting. Drugs 2000; 59:213-43.
29. Gan TJ. Postoperative nausea and vomiting-can it be eliminated? JAMA 2002; 287:1233-6.
30. Domino KB, Anderson EA, Polissar NL, Posner KL. Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: a meta-analysis. Anesth Analg 1999; 88:1370-9.
31. Fujji Y, Tanaka H, Kobayashi N. Prevention of nausea and vomiting after middle ear surgery: granisetron versus ramosetron. Laryngoscope 1999; 109:1988-90.
32. Numazaki M, Fujii Y. Subhypnotic dose of propofol for the prevention of nausea and vomiting during spinal anaesthesia for caesarean section. Anaesth Intensive Care 2000; 28:262-5.
33. Tarhan Ö, Canbay Ö, Çelebi N, Uzun S, Sahin A, Coskun F, et al. Subhypnotic doses of midazolam prevent nausea and vomiting during spinal anaesthesia for caesarean section. Minerva Anestesiol 2007; 73:629-33.
34. Splinter WM, MacNeill HB, Menard EA, Rhine EJ, Roberts DJ, Gould MH. Midazolam reduces vomiting after tonsillectomy in children. Can J Anaesth 1995; 42:201-3.
35. Heidari SM, Saryazdi H, Saghaei M. Effect of intravenous midazolam premedication on postoperative nausea and vomiting after cholecystectomy. Acta Anaesthesiol Taiwan 2004; 42:77-80.
36. Caba F, Echevarría M, Bernal-Dávalos L, Pallarés-González JA, Rodríguez-Rodríguez R.Prophylaxis of intraoperative nausea and vomiting with sub-hypnotic dose of propofol during intradural anesthesia in cesarean section. Rev Esp Anestesiol Reanim 1997; 44:262-6.
37. Rasooli S, Moslemi F, Khaki A. Effect of Sub hypnotic Doses of Propofol and Midazolam for Nausea and Vomiting During Spinal Anesthesia for Cesarean Section. Anesth Pain Med 2014;4:e19384.
38. Kestin IG. Spinal anesthesia in obstetrics. Br J Anaesth 1991; 66:596-607.
39. Miller RD, Eriksson LI, Fleisher L, Wiener-Kronish JP, Young WL. Miller’s Anesthesia. 2009;1:6624-8.
40. Elhakim M, Ali NM. Dexamethason reduce postoperative vomiting and pain after tonsillectomy. Can J Anaesth 2003; 50:392-7.
41. Henzi I, Walder B, Tramer MR. Dexamethasone for the prevention of past operative nausea and vomiting. Aresth Analg 2000; 90:186-94.
42. Sane S, Valizadeh Hasanlui MA, Abbasivash R, Mahoori A, Hashemi ST, Rafiei F. Comparing the effect of intravenous dexamethasone, intravenous ondansetron, and their combination on nausea and vomiting in cesarean section with spinal anesthesia. Adv Biomed Res 2015; 4:230.
43. Danielak-Nowak M, Musioł E, Arct-Danielak D, Duda I, Ludwik K. A comparison of subhypnotic doses of propofol and midazolam during spinal anaesthesia for elective Caesarean section. Anaesthesiol Intensive Ther 2016; 48:13-8.
44. Shahriari A, Khooshideh M, Heidari MH. Prevention of nausea and vomiting in caesarean section under spinal anaesthesia with midazolam or metoclopramide? J Pak Med Assoc 2009; 59:756-9.
45. Kalani N, Zabetian H, Sanie MS, Deylami M, Radmehr M, Sahraei R, et al. The Effect of Ondansetron and Dexamethasone on Nausea and Vomiting under Spinal Anesthesia. World J Plast Surg 2017; 6:88-93.
46. Kim EG, Park HJ, Kang H, Choi J, Lee HJ. Antiemetic effect of propofol administered at the end of surgery in laparoscopic assisted vaginal hysterectomy. Korean J Anesthesiol 2014; 66:210-5.
47. Hammas B, Hvarfner A, Thörn SE, Wattwil M. Effects of propofol on ipecacuanha induced nausea and vomiting. Acta Anesthesiol Scand 2008:42:23-5.
48. Movafegh A, Soroush AR, Navi A, Sadeghi M, Esfehani F, et al. The effect of intravenous administration of dexamethasone on postoperative pain, nausea, and vomiting after intrathecal injection of mepridine. Anesth Analg 2007; 104:987-9.
2. Eberhart LH, Högel J, Seeling W, Staack AM, Geldner G, Georgieff M. Evaluation of three risk scores to predict postoperative nausea and vomiting. Acta Anaesthesiol Scand 2000; 44:480-8.
3. Darkow T, Gora-Harper ML, Goulson DT, Record KE. Impact of antiemetic selection on postoperative nausea and vomiting and patient satisfaction. Pharmacotherapy 2001; 21:540-8.
4. Schumann R, Polaner DM. Massive subcutaneous emphysema and sudden airway compromise after postoperative vomiting. Anesth Analg. 1999; 89:796-7.
5. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004; 350:2441-51.
6. Lussos SA, Bader AM, Thornhill ML, Datta S. The antiemetic efficacy and safety of prophylactic metoclopramide for elective cesarean delivery during spinal anesthesia. Reg Anesth 1992; 17:126-30.
7. Santos A, Datta S. Prophylactic use of droperidol for control of nausea and vomiting during spinal anesthesia for cesarean section. Anesth Analg 1984; 63:85-7.
8. Harmon D, Ryan M, Kelly A, Bowen M. Acupressure and prevention of nausea and vomiting during and after spinal anesthesia for caesarean section. Br J Anaesth 2000; 84:463-7.
9. Crocker JS, Vandam LD. concerning nausea and vomiting during spinal anesthesia. Anesthesiology 1959; 20:587-92.
10. Ratra CK, Badola RP, Bhargava KP. A study of factors concerned in emesis during spinal anaesthesia. Br J Anaesth 1972; 44:1208-11.
11. Balki M, Carvalho JC. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. Int J Obstet Anesth 2005; 14:230-41.
12. Pan PH, Moore CH. Intraoperative antiemetic efficacy of prophylactic ondansetron versus droperidol for cesarean section patients under epidural anesthesia. Anesth Analg 1996; 83:982-6.
13. Balki M, Kasodekar S, Dhumne S, Carvalho JC. Prophylactic granisetron does not prevent postdelivery nausea and vomiting during elective cesarean delivery under spinal anesthesia. Anesth Analg 2007; 104:679-83.
14. Pan PH, Moore CH. Comparing the efficacy of prophylactic metoclopramide, ondansetron, and placebo in cesarean section patients given epidural anesthesia. J Clin Anesth 2001; 13:430-5.
15. Hesketh PJ. Comparative review of 5-HT3 receptor antagonists in the treatment of acute chemotherapy-induced nausea and vomiting. Cancer Invest 2000; 18:163-73.
16. De Oliveira GS, Jr, Castro-Alves LJ, Ahmad S, Kendall MC, McCarthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: An updated meta-analysis of randomized controlled trials. Anesth Analg 2013; 116:58-74.
17. Leeser J, Lip H. Prevention of postoperative nausea and vomiting using ondansetron, a new, selective, 5-HT3 receptor antagonist. Anesth Analg 1991; 72:751-5.
18. Scuderi P, Wetchler B, Sung YF, Mingus M, DuPen S, Claybon L, et al. Treatment of postoperative nausea and vomiting after outpatient surgery with the 5-HT3 antagonist ondansetron. Anesthesiology 1993; 78:15-20.
19. Wang JJ, Ho ST, Lee SC, Liu YC, Liu YH, Liao YC. The prophylactic effect of dexamethasone on postoperative nausea and vomiting in women undergoing thyroidectomy: A comparison of droperidol with saline. Anesth Analg 1999; 89:200-3.
20. Tzeng JI, Wang JJ, Ho ST, Tang CS, Liu YC, Lee SC. Dexamethasone for prophylaxis of nausea and vomiting after epidural morphine for post-caesarean section analgesia: Comparison of droperidol and saline. Br J Anaesth 2000; 85:865-8.
21. Parrington SJ, O’Donnell D, Chan VW, Brown-Shreves D, Subramanyam R, Qu M, et al. Dexamethasone added to mepivacaine prolongs the duration of analgesia after supraclavicular brachial plexus blockade. Reg Anesth Pain Med 2010; 35:422-6.
22. Wattwil M, Thörn SE, Lövqvist A, Wattwil L, Gupta A, Liljegren G. Dexamethasone is as effective as ondansetron for the prevention of postoperative nausea and vomiting following breast surgery. Acta Anaesthesiol Scand 2003; 47:823-7.
23. Draisci G, Valente A, Suppa E, Frassanito L, Pinto R, Meo F, et al. Remifentanil for cesarean section under general anesthesia: effects on maternal stress hormone secretion and neonatal well-being: a randomized trial. Int J Obstet Anesth 2008; 17:130-6.
24. Marucci M, Diele C, Bruno F, Fiore T. Subarachnoid anaesthesia in caesarean delivery: effects on alertness. Minerva Anesthesiol 2003; 69:809-19.
25. Ryding EL, Wijma B, Wijma K. Posttraumatic stress reactions after emergency cesarean section. Acta Obstet Gynecol Scand 1997; 76:856-61.
26. Ramsay MA, Savege TM, Simpson BR. Controlled sedation with alphaxolone-alphadalone. Br Med J 1974; 2:656-9.
27. Patki A, Shelgaonkar VC. A Comparison of equisedative infusions of propofol and midazolam for conscious sedationduring spinal anesthesia - a prospective randomized study. J Anaesthesiol Clin Pharmacol 2011; 27:47-53.
28. Kovac AL. Prevention and treatment of postoperative nausea and vomiting. Drugs 2000; 59:213-43.
29. Gan TJ. Postoperative nausea and vomiting-can it be eliminated? JAMA 2002; 287:1233-6.
30. Domino KB, Anderson EA, Polissar NL, Posner KL. Comparative efficacy and safety of ondansetron, droperidol, and metoclopramide for preventing postoperative nausea and vomiting: a meta-analysis. Anesth Analg 1999; 88:1370-9.
31. Fujji Y, Tanaka H, Kobayashi N. Prevention of nausea and vomiting after middle ear surgery: granisetron versus ramosetron. Laryngoscope 1999; 109:1988-90.
32. Numazaki M, Fujii Y. Subhypnotic dose of propofol for the prevention of nausea and vomiting during spinal anaesthesia for caesarean section. Anaesth Intensive Care 2000; 28:262-5.
33. Tarhan Ö, Canbay Ö, Çelebi N, Uzun S, Sahin A, Coskun F, et al. Subhypnotic doses of midazolam prevent nausea and vomiting during spinal anaesthesia for caesarean section. Minerva Anestesiol 2007; 73:629-33.
34. Splinter WM, MacNeill HB, Menard EA, Rhine EJ, Roberts DJ, Gould MH. Midazolam reduces vomiting after tonsillectomy in children. Can J Anaesth 1995; 42:201-3.
35. Heidari SM, Saryazdi H, Saghaei M. Effect of intravenous midazolam premedication on postoperative nausea and vomiting after cholecystectomy. Acta Anaesthesiol Taiwan 2004; 42:77-80.
36. Caba F, Echevarría M, Bernal-Dávalos L, Pallarés-González JA, Rodríguez-Rodríguez R.Prophylaxis of intraoperative nausea and vomiting with sub-hypnotic dose of propofol during intradural anesthesia in cesarean section. Rev Esp Anestesiol Reanim 1997; 44:262-6.
37. Rasooli S, Moslemi F, Khaki A. Effect of Sub hypnotic Doses of Propofol and Midazolam for Nausea and Vomiting During Spinal Anesthesia for Cesarean Section. Anesth Pain Med 2014;4:e19384.
38. Kestin IG. Spinal anesthesia in obstetrics. Br J Anaesth 1991; 66:596-607.
39. Miller RD, Eriksson LI, Fleisher L, Wiener-Kronish JP, Young WL. Miller’s Anesthesia. 2009;1:6624-8.
40. Elhakim M, Ali NM. Dexamethason reduce postoperative vomiting and pain after tonsillectomy. Can J Anaesth 2003; 50:392-7.
41. Henzi I, Walder B, Tramer MR. Dexamethasone for the prevention of past operative nausea and vomiting. Aresth Analg 2000; 90:186-94.
42. Sane S, Valizadeh Hasanlui MA, Abbasivash R, Mahoori A, Hashemi ST, Rafiei F. Comparing the effect of intravenous dexamethasone, intravenous ondansetron, and their combination on nausea and vomiting in cesarean section with spinal anesthesia. Adv Biomed Res 2015; 4:230.
43. Danielak-Nowak M, Musioł E, Arct-Danielak D, Duda I, Ludwik K. A comparison of subhypnotic doses of propofol and midazolam during spinal anaesthesia for elective Caesarean section. Anaesthesiol Intensive Ther 2016; 48:13-8.
44. Shahriari A, Khooshideh M, Heidari MH. Prevention of nausea and vomiting in caesarean section under spinal anaesthesia with midazolam or metoclopramide? J Pak Med Assoc 2009; 59:756-9.
45. Kalani N, Zabetian H, Sanie MS, Deylami M, Radmehr M, Sahraei R, et al. The Effect of Ondansetron and Dexamethasone on Nausea and Vomiting under Spinal Anesthesia. World J Plast Surg 2017; 6:88-93.
46. Kim EG, Park HJ, Kang H, Choi J, Lee HJ. Antiemetic effect of propofol administered at the end of surgery in laparoscopic assisted vaginal hysterectomy. Korean J Anesthesiol 2014; 66:210-5.
47. Hammas B, Hvarfner A, Thörn SE, Wattwil M. Effects of propofol on ipecacuanha induced nausea and vomiting. Acta Anesthesiol Scand 2008:42:23-5.
48. Movafegh A, Soroush AR, Navi A, Sadeghi M, Esfehani F, et al. The effect of intravenous administration of dexamethasone on postoperative pain, nausea, and vomiting after intrathecal injection of mepridine. Anesth Analg 2007; 104:987-9.
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| Issue | Vol 59, No 12 (2021) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v59i12.8059 | |
| Keywords | ||
| Propofol Dexamethasone Ondansetron Nausea Vomiting Cesarean section | ||
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How to Cite
1.
Hassani E, Karami N, Hassani A, Hassani L, Ashraf V. Comparison of the Prophylactic Effect of Propofol, Dexamethasone and Ondansetron on Post-Operative Nausea and Vomiting in Elective Cesarean Section Under Spinal Anesthesia. Acta Med Iran. 2021;59(12):713-719.
