Intravenous dexamethasone combined with intrathecal atropine to prevent morphine-related nausea and vomiting after cesarean delivery: A randomized double-blinded study

Abstract

Background: Intrathecal morphine can be considered as a gold standard for analgesia following cesarean section (CS), which is not devoid of complications namely postoperative nausea and vomiting. We evaluated the antiemetic effect of intravenous dexamethasone combined with intrathecal atropine after CS. Methods: 120 parturient undergoing elective CS under spinal anesthesia were randomized into three groups. Dexamethasone group (D): Received intrathecal hyperbaric bupivacaine (0.5% in 2 ml) mixed with morphine (200 µg in 0.5 ml) and normal saline (0.5 ml as placebo) and intravenous (iv) dexamethasone (8 mg in 2 ml). Atropine group (A): Received hyperbaric bupivacaine (0.5% in 2 ml) mixed with morphine (200 µg in 0.5 ml) and atropine (100 µg in 0.5 ml), in addition to iv normal saline (2 ml as placebo). Dexamethasone and Atropine group (DA): Received intrathecally as group A, and iv dexamethasone (8 mg in 2 ml). Follow-up of both nausea and vomiting was done during the first 24 hours postoperatively. Results: Nausea was noticed in 7 patients (17.5%) in group D, 8 patients (20%) in group A, and one patient (2.5%) group DA, with significant differences between DA and D (p = 0.025) and DA and A (p = 0.013). Regarding vomiting, there were 5 patients (12.5%) in group D, 4 patients (10%) in group A only, with significant differences between DA and D (p = 0.021) and DA and A (p = 0.041). Conclusions: Combination of intravenous dexamethasone and intrathecal atropine has additive antiemetic effect after spinal anesthesia for cesarean delivery using bupivacaine and morphine.

Prevention and management of postoperative nausea and vomiting after cesarean section: A systematic literature review

“… Polanosetron Prophylaxis is more effective than ramosetron prophylaxis for the long-term prevention of PONV after cesarean section. Low 15 Kampo S et al [ 32 ], 2019 Ghana 30 345 RCT Sub-hypnotic dose of Propofol as antiemetic prophylaxis attenuates intrathecal morphine-induced postoperative nausea and vomiting, and pruritus in parturient undergoing cesarean section sub-hypnotic dose of Propofol has the same effectiveness as metoclopramide in the prevention of PONV in women undergoing cesarean section under spinal anesthesia with adjunct intrathecal morphine Low 16 Abdalla E et al [ 33 ] 2019 Egypt 120 RCT Intravenous dexamethasone combined with intrathecal atropine to prevent morphine-related nausea and vomiting after cesarean delivery. Combination of IV dexamethasone and intrathecal atropine has additive antiemetic effect after SA for CS using bupivacaine and morphine low 17 Jabalameli M et al [ 8 ] 2012 Iran 31.5 132 RCT Treatment of postoperative nausea and vomiting after spinal anesthesia for cesarean delivery: comparison of midazolam, ondansetron, and a combination.…”

“…The NICE guideline recommends that Women having a cesarean section should be offered antiemetic (either pharmacological or non-pharmacological) to reduce nausea and vomiting during Cesarean section [ 34 ]. The most commonly practiced antiemetic prophylaxis agents include serotonin antagonists (like ondansetron, granisetron, palonosetron, tropisetron), dopamine antagonists (metoclopramide), and corticosteroids (dexamethasone) [ 13 , 24 , 26 , 27 , 31 , 33 , 35 ]. Whereas Acupressure, Acupuncture, and ginger are the non-pharmacological approaches discussed in this literature review for the prevention of PONV [ [18] , [19] , [20] , [21] , [22] , [23] ].…”

The effects of laparoscopic guided transversus abdominis plane (TAP) block in sleeve gastrectomy procedure: a randomized single blinded placebo controlled trial

“…9,24 Opioids are commonly used in postoperative pain management regimens in almost all types of surgery. 25 However, despite their analgesic efficacy, they also cause a number of adverse effects, including nausea and vomiting, respiratory depression, constipation, and hypotension. 26 Opioid addiction is another problem, with up to 10% patients exhibiting opioid addiction after bariatric surgery, meaning that their use should be as limited as possible.…”