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ANTIEMETIC PROPHYLAXIS DURING SPINAL ANALGESIA FOR CAESAREAN DELIVERY: A COMPARISON OF ONDANSETRON AND METOCLOPRAMIDE
ABSTRACT
This prospective, randomized, placebo controlled, double blind study was
performed to compare the effectiveness of ondansetron and metoclopramide in limiting
the frequency of intraoperative nausea and vomiting during spinal analgesia for
Caesarean delivery.
One hundred and fifty full term parturients, American Society of
Anesthesiologists (ASA) physical status I-II requiring elective Caesarean section were
randomly assigned into one of three treatment groups. After the umbilical cord clamping,
ondansetron 4mg (n=50), metoclopramide 10mg (n=50) or 0.9% saline 2ml (n=50) was
administered intravenously depending on the treatment group selected preoperatively.
The patient assessed the presence and degree of nausea while the attending
anaesthetist noted the presence and degree of retching and vomiting. The study continued
for 2 hours to cover the immediate postoperative period.
The frequency of nausea in the intraoperative post delivery period was 34% with
placebo, 6% with metoclopramide and 4% with ondansetron. The frequency of retching
or vomiting was 10% with placebo, 2% with both metoclopramide and ondansetron.
(P< 0.05). The frequency of nausea, retching or vomiting correlated with the occurrence
of hypotension.
For those patients that experienced nausea, the median severity score was reduced
from 7.0 for placebo to 5.0 for metoclopramide and 4.5 for ondansetron treated groups
on numerical rating scale (NRS). The mean number of vomiting episode was reduced
from 2 in the control group to 1 for both metoclopramide and ondansetron groups.
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There is a significantly lower frequency of nausea and vomiting and a tendency
towards less severe emetic symptoms in the ondansetron and metoclopramide groups
compared to the placebo group. Both prophylactic ondansetron and metoclopramide are
similarly effective in reducing the frequency of intraoperative emetic symptoms during Caesarean delivery under spinal analgesia.
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