Intrathecal Fentanyl Is Superior to Intravenous Ondansetron for the Prevention of Perioperative Nausea During Cesarean Delivery with Spinal Anesthesia

Abstract

This study compares intrathecal (IT) fentanyl with IV ondansetron for preventing intraoperative nausea and vomiting during cesarean deliveries performed with spinal anesthesia. Thirty healthy parturients presenting for elective cesarean delivery with standardized bupivacaine spinal anesthesia were randomized to receive 20 microg IT fentanyl (Group F) or 4 mg IV ondansetron (Group O) by using double-blinded methodology. At eight specific intervals during the surgery, a blinded observer questioned the patient about nausea (1 = nausea, 0 = no nausea), observed for the presence of retching or vomiting (1 = vomiting or retching, 0 = no vomiting or retching), and recorded a verbal pain score (0-10, 0 = no pain, 10 = worst pain imaginable). Cumulative nausea, vomiting, and pain scores were calculated as the sum of the eight measurements. Intraoperative nausea was decreased in the IT fentanyl group compared with the IV ondansetron group: the median (interquartile range) difference in nausea scores was 1 (1, 2), P = 0.03. The incidence of vomiting and treatment for vomiting was not different (P = 0.7). The IT fentanyl group had a lower cumulative perioperative pain score than the IV ondansetron group; the median difference in the cumulative pain score was 12 (8, 16) (P = 0.0007). The IT fentanyl group required less supplementary intraoperative analgesia. The median difference in the cumulative fentanyl dose was 100 (75, 100) microg fentanyl, (P = 0.0002).

Comparison of unilateral spinal anaesthesia using low dose bupivacaine with or without fentanyl in lower limb surgery

“…The results are similar to the findings of Singh et al, found pruritus (10%) and Khanna et al has found pruritus in 20% of patients with 25 µg fentanyl. 22,31 Nausea, vomiting was not observed in this study and supported by similar studies by Singh et al and Manullang et al 22,32 The postoperative analgesia was also significantly higher (p =0.000) in Group BF (266.37±9.47 minutes) than in Group B (162.97±9.26 minutes) and the results were correlated with finding of Korhonen et al and Khanna et al 1,31 In this study 14 patients (47%) in group B and 6 (20%) patients in group BF were fast tracked in general ward. Sixteen patients (53%) and 24 (80%) patients in group B and group BF respectively needed to be shifted to PACU and they remained there for 15.69±3.85 and 30.13±10.79 minutes respectively.…”

Randomized, Placebo-Controlled Trial of Granisetron for Control of Nausea and Vomiting During Cesarean Delivery Under Spinal Anesthesia

“…Retching was defined as the labored, spasmodic, and rhythmic contraction of the respiratory muscles without the expulsion of gastric contents. Vomiting was defined as the forceful expulsion of gastric contents from mouth [6].…”

“…The Journal of Obstetrics and Gynecology of India (July-August 2012) 62(4):419-423 Randomized, Placebo Controlled Trial of Granisetron techniques [5], peritoneal traction, and exteriorization of uterus [6]. Maternal hypotension after induction of spinal anesthesia may trigger the vomiting center to induce emesis due to hypoxia [7].…”

Can we keep our mothers happy and our babies safe?

“…A randomized double-blinded study of women undergoing elective Cesarean delivery under spinal anesthesia found that intrathecal fentanyl was superior for the prevention of intraoperative nausea when compared with intravenous ondansetron given at the time of spinal placement. 5 In this study, spinal opioids actually reduced nausea during Cesarean delivery, perhaps related to better quality of analgesia. It would be a shame if all these benefits for the mother in labour came with a negative impact on the fetus or newborn.…”

“…Une étude randomisée à double insu chez des femmes subissant une césarienne programmée sous rachianesthésie a montré que le fentanyl intrathécal était supérieur pour la prévention des nausées peropératoires lorsque comparé à l'ondansétron intraveineux administré au moment du placement du cathéter de rachianesthésie. 5 Au cours de cette étude, les opioïdes rachidiens ont effectivement diminué les nausées au cours de la césarienne, peut-être en rapport avec une meilleure qualité de l'analgésie. 6 En utilisant trois différentes méthodes d'évaluation des nouveau-nés, les auteurs ont réduit la probabilité de passer à côté d'un effet indésirable.…”