Prevention of postoperative nausea and vomiting after intrathecal morphine for cesarean section: a randomized comparison of dexamethasone, droperidol, and a combination

Wu, Jyh-I; Lo, Yuan Hung; Chia, Yuan-Yi; Liu, K.; Fong, Wen-Po; Yang, Lin-Cheng; Tan, Ping-Heng

doi:10.1016/j.ijoa.2006.11.004

Cited by 69 publications

(95 citation statements)

References 33 publications

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“…Since nausea and vomiting can occur by a variety of different mechanisms, combinations of different antiemetics are used to prevent or treat these symptoms 6,21 . By the help of these combinations, multiple routes that can lead to nausea and vomiting can be blocked 22 . Effect of addition of dexamethasone to ondansetron in the control of postoperative nausea and vomiting (PONV) has been studied before , but we could not find any study in the literature that investigated the efficacy of this combination for the control of postdelivery IONV.…”

Section: Introductionmentioning

confidence: 99%

Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia

Demırhan¹,

Tekelioglu²,

Akkaya³

et al. 2013

Afr H. Sci.

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Background: Nausea and vomiting are frequently seen in patients undergoing cesarean section (CS) under regional anesthesia. We aimed to compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the use of each agent alone to decrease the incidence of post-delivery intraoperative nausea and vomiting (IONV) during CS under spinal anesthesia. Objective: To compare the antiemetic efficacy of ondansetron and dexamethasone combination with that of the single use of each agent to decrease the incidence of postdelivery IONV during CS under spinal anesthesia. Methods: A randomized, prospective, double blind study was performed on 90 patients undergoing planned CS under spinal anesthesia. Patients received 4mg ondansetron in Group O, 8mg dexamethasone in GroupD, 4mg ondansetron+8mg dexamethasone in Group OD intravenously within 1-2 minutes after the umbilical cord was clamped. Frequency of postdelivery IONV episodes was recorded. Results: A total of 86 eligible patients were included in the study. There were 29 patients in Group O, 29 patients in Group D and 28 patients in Group OD. There were no statistically significant difference between the groups in terms of baseline characteristics and intraoperative managements. Frequency of intraoperative nausea, retching and vomiting experiences were similar between the groups(p>0.05). Conclusion: Single dose 4mg ondansetron, 8mg dexamethasone, or combined use of 8mg dexamethasone+4mg ondansetron, given intravenously is all effective agents for the control of postdelivery IONV. Combined use of dexamethasone and ondansetron for the same indication does not seem to increase the antiemetic efficacy.

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Section: Introductionmentioning

confidence: 99%

Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia

Demırhan¹,

Tekelioglu²,

Akkaya³

et al. 2013

Afr H. Sci.

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“…Despite increasing dosage of morphine, the dose-response of 7.5 and 10 mg/kg of morphine were less than 5 mg/kg, especially 7.5 mg/kg. This different response can be related to neuroplasticity and adaptation (22) and disorders such as respiratory problems (23), nausea and vomiting (24) and drowsiness (25) due to morphine receiving. Also, it can be related to the response of different sections of brain to morphine.…”

Section: Discussionmentioning

confidence: 99%

The Blockade of Glutamate N-methyl-D-aspartate Receptors into the Prelimbic of Prefrontal Cortex Decreases Morphine-induced Conditioned Place Preference in Rat

et al. 2017

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B ACKGROUND:The prelimbic area (PL) of the prefrontal cortex is susceptible to abnormal developmental stimuli that raises the risk of addiction. Glutamate receptors play a key role in opiate reinforcement and reward functions in this area. Therefore, we examined the effect of the DL-2-amino-5-phosphonopentanoic acid (AP5), as N-methyl-D-aspartate (NMDA) receptor antagonist into the PL on the phases of conditioned place preference (CPP) induced by morphine. METHODS:Male Wistar rats were divided into 12 groups (3 surgical groups for each dose of morphine in any phase of CPP) and anaesthetized with chloral hydrate. Cannula was implanted into the PL and the AP5 was injected into this area and morphine-induced CPP was investigated. Data were processed with the commercially available SPSS 22 software using one-way ANOVA and Tukey's test. p<0.05 were considered statistically significant. RESULTS:Our findings indicated, morphine in doses of 2.5 to 10 mg/kg induced CPP. Microinjection of various doses of the AP5 into the PL before the administration of the effective dose of morphine significantly reduced place preference in the acquisition and the expression phases of the CPP test compared to the sham group (p<0.001). In another set of our experiments was seen that, different doses of the AP5 with the ineffective dose of morphine only reduced the expression phase of the CPP (p<0.001) while, produced neither preference nor aversion effect on the acquisition phase (p=0.147). CONCLUSION:It seems that the glutamate NMDA receptors in the PL through memory formation and morphine-related reward signals play a critical role in addiction process during morphine-induced CPP. KEYWORDS

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“…Patients deficient in vitamin B12, including those with a subclinical deficiency (ie without an associated anaemia), may develop a severe and progressive myeloneuropathy even after brief exposure to N 2 O. There are many examples of such case reports (Schilling, 1986;Holloway & Alberico, 1990;Flippo & Holder, 1993;Kinsella & Green, 1995;Nestor & Stark, 1996;Rosener & Dichgans, 1996;Sesso et al, 1999;Marie et al, 2000;Waters et al, 2005;Cartner et al, 2007;Wu et al, 2007;Meyers & Judge, 2008;Singer et al, 2008;Somyreddy & Kothari, 2008). Those at risk of vitamin B12 deficiency include some vegetarians (in particular vegans), the newborn of vegetarian mothers, patients with GI pathology, elderly people or patients taking PPIs and H2 blockers, and alcoholics (Schilling, 1986;Rosener & Dichgans, 1996;Nilsson-Ehle, 1998;Schenk et al, 1999;Carmel, 2000;McNeely et al, 2000;Sanders et al, 2008).…”

Section: Toxicitymentioning

confidence: 99%

“…Patients with SACD related to N 2 O exposure may sometimes show improvement after administration of vitamin B12 +/-methionine (Wu et al, 2007;Meyers & Judge, 2008;Singer et al, 2008) although this is not always the case.…”

Section: Chaptermentioning

confidence: 99%

“…Ondansetron or scopolamine was equally effective in reducing emesis with intrathecal morphine analgesia for Caesarean section, although scopolamine use was associated with more anticholinergic side effects (Harnett et al, 2007 Level II). The combination of ondansetron with either dexamethasone or droperidol had a better antiemetic effect after gynaecological surgery compared with droperidol plus dexamethasone (Sanchez-Ledesma et al, 2002 Level II); although dexamethasone plus droperidol was superior to either alone (Wu et al, 2007 Level II).…”

Section: Chaptermentioning

confidence: 99%

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Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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Prevention of postoperative nausea and vomiting after intrathecal morphine for cesarean section: a randomized comparison of dexamethasone, droperidol, and a combination

Cited by 69 publications

References 33 publications

Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia

Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia

The Blockade of Glutamate N-methyl-D-aspartate Receptors into the Prelimbic of Prefrontal Cortex Decreases Morphine-induced Conditioned Place Preference in Rat

Safety of opioid patch initiation in Australian residential aged care

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