How to Cite
Parra-Güiza, R., Meléndez, H. J., & Ochoa, M. E. (2018). Prophylactic efficacy of ondansetron and dexamethasone in nausea and vomit in patients undergoing cesarean section with neuraxial opioids. Controlled clinical trial. Médicas UIS, 31(1), 31–38. https://doi.org/10.18273/revmed.v31n1-2018004
Abstract
Background: Subarachnoid anesthesia is the most common technique for cesarean section and coadjuvant opioids such as morphine
and fentanyl have adverse events, predominantly nausea and vomit. A randomized, placebo-controlled trial was performed to evaluate
the prophylactic effect of ondansetron and dexamethasone on these events. Objective: To establish the efficacy of ondansetron and
dexamethasone in nausea and vomit prophylaxis in patients undergoing cesarean section. Method: A sample of 300 pregnant women
was randomized in 3 groups: dexamethasone 4 mg, ondansetron 4 mg, and placebo. Standardized dose of 9 mg of bupivacaine at 0,5%
100 mcg of morphine and 25 mcg of intratechal fentanyl were administered to all patients. Both dexamethasone and ondansetron were
compared against placebo. Emergency cesarean section, ASA III and allergic patients to any study drugs were excluded. Nausea and
vomiting were evaluated intraoperative, 2, 6 and 24 hours after anesthesia, with a significance level α of 0,05. Results: On dexamethasone
group the RR for vomit was 0,46 (CI 95% 0,28 to 0,76) and 0,79 (CI 95% 0, 64-0,96) for nausea. On the ondansetron group, it was 0.41 (CI
95% 0,24- 0,69) for vomit and 0,75 (CI 95% 0,67 a 0,84) for nausea. The severity of nausea was statistically lower on the ondansetron group
References
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administration of ondansetron in the prevention of postoperative
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delivery. Indian J Anaesth. 2003;47(3):178-80.
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for the prevention and treatment of pruritus, nausea, and
vomiting in women undergoing cesarean delivery with
intrathecal morphine: a systematic review and meta-analysis.
Anesth Analg. 2009;109(1):174-82.
9. Allen TK, Jones CA, Habib AS. Dexamethasone for the
prophylaxis of postoperative nausea and vomiting associated
with neuraxial morphine administration: a systematic review
and meta-analysis. Anesth Analg. 2012;114(4):813-22.
10. Griffiths JD, Gyte GML, Paranjothy S, Brown HC, Broughton HK,
Thomas J. Interventions for preventing nausea and vomiting in
women undergoing regional anaesthesia for caesarean section.
Cochrane Database Syst Rev. 2012;12(9):CD007579.
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intrathecal morphine. Eur J Anaesthesiol. 2006;23(8):670-5.
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of Anaesthetists. Classification of Urgency of Caesarean Section –
a continuum of Risk (Good Practice No. 11). RCOG. 2010.
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Prophylaxis for Control of Postoperative Nausea and Vomiting
after Cesarean Delivery under Spinal Anesthesia. J Obstet
Gynaecol India. 2015;65(1):28-33.
14. Harnett MJ, O’Rourke N, Walsh M, Carabuena JM, Segal
S. Transdermal scopolamine for prevention of intrathecal
morphine-induced nausea and vomiting after cesarean delivery.
Anesth Analg. 2007;105(3):764-9.
15. Dominguez JE, Habib AS. Prophylaxis and treatment of the
side-effects of neuraxial morphine analgesia following cesarean
delivery. Curr Opin Anaesthesiol. 2013;26(3):288-95.
16. Iqbal IM, Spencer R. Postoperative nausea and vomiting. Anaesth
Intensive Care Med. 2012;13(12):613-6.
17. Horn CC, Wallisch WJ, Homanics GE, Williams JP.
Pathophysiological and neurochemical mechanisms of
postoperative nausea and vomiting. Eur J Pharmacol. 2014;
722(1):55–66.
18. Balki M, Carvalho JC. Intraoperative nausea and vomiting during
cesarean section under regional anesthesia. Int J Obstet Anesth.
2005;14(3):230–41.
19. Wu JI, Lo Y, Chia YY, Liu K, Fong WP, Yang LC, et al. Prevention
of postoperative nausea and vomiting after intrathecal
morphine for cesarean section: a randomized comparison of
dexamethasone, droperidol, and a combination. Int J Obstet
Anesth. 2007;16(2):122–7.
20. Cardoso MM, Leite AO, Santos EA, Gozzani JL, Mathias LA.
Effect of dexamethasone on prevention of postoperative nausea,
vomiting and pain after caesarean section: a randomised,
placebo-controlled, double-blind trial. Eur J Anaesthesiol.
2013;30(3):102–5.
21. Girgin NK, Gurbet A, Turker G, Aksu H, Gulhan N. Intrathecal
morphine in anesthesia for cesarean delivery: dose-response
relationship for combinations of low-dose intrathecal morphine
and spinal bupivacaine. J Clin Anesth. 2008;20(3):180–5.
22. Carvalho FA, Tenório SB. Comparative study between doses of
intrathecal morphine for analgesia after caesarean. Brazilian J
Anesthesiol. 2013;63(6):492–9.
23. Borgeat A, Ekatodramis G, Schenker C. Postoperative nausea
and vomiting in regional anesthesia: a review. Anesthesiology.
2003;(2):530–47.
24. Imeh A, Olaniyi O, Simeon O, Omotola O. Dexamethasone
versus a combination of dexamethasone and ondansetron
as prophylactic antiemetic in patients receiving intrathecal
morphine for caesarean section. Afr Health Sci. 2014;14(2):453–9.
25. Kung AT, Yang X, Li Y, Vasudevan A, Pratt S, Hess P. Prevention
versus treatment of intrathecal morphine-induced pruritus with
ondansetron. Int J Obstet Anesth. 2014;23(3):222–6.
26. 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(1):58–74.
27. García Márquez MJ, García Corzo CM. Náusea y vómito
secundarios a la limpieza peritoneal en cesárea bajo anestesia
subaracnoidea. Eficacia de la asociación fentanyl-midazolam.
Ensayo Clínico Controlado. Rev Colomb Anestesiol.
2007;35(1):29–35.
28. Meléndez Flórez HJ, Gamarra HG, Fernández C, Dulcey R.
Eficacia del fentanyl adicionado a bupivacaina en el dolor
intraoperatorio en cesárea bajo anestesia subaracnoidea. Ensayo
clínico controlado. Rev Colomb Anestesiol. 2005;33(3):161–8.
29. Manullang TR, Viscomi CM, Pace NL. Intrathecal fentanyl
is superior to intravenous ondansetron for the prevention of
perioperative nausea during cesarean delivery with spinal
anesthesia. Anesth Analg. 2000;90(5):1162–6.
cesarean section delivery. Colomb J Anesthesiol [Internet]. 1 Ago
2012 [consultado 25 Jul 2016];40(3):203–6.
2. Bujedo BM. Clinical Use of Spinal Opioids for Postoperative Pain.
Journal of the Analgesics. [Internet]. Dic 2015 [consultado 25 Jul
2016] 2015;3(2)17–23. Disponible en: https://www.researchgate.
net/publication/301246179_Clinical_Use_of_Spinal_Opioids_
for_Postoperative_Pain
3. Pöpping DM, Elia N, Marret E, Wenk M, Tramr MR. Opioids
added to local anesthetics for single-shot intrathecal anesthesia
in patients undergoing minor surgery: A meta-analysis of
randomized trials. Pain. 2012;153(4):784–93.
4. Dahl JB, Jeppesen IS, Jørgensen H, Wetterslev J, Møiniche
S. Intraoperative and Postoperative Analgesic Efficacy and
Adverse Effects of Intrathecal Opioids in Patients Undergoing
Cesarean Section with Spinal Anesthesia. Anesthesiology.
1999;91(6):1919-27.
5. Gehling M, Tryba M. Risks and side-effects of intrathecal
morphine combined with spinal anaesthesia: A meta-analysis.
Anaesthesia. 2009;64(6):643–51.
6. Pan AK, Rudra A. Prophylactic single dose intravenous
administration of ondansetron in the prevention of postoperative
emetic symptoms during spinal anaesthesia for caesarean
delivery. Indian J Anaesth. 2003;47(3):178-80.
7. Nortcliffe SA, Shah J, Buggy DJ. Prevention of postoperative
nausea and vomiting after spinal morphine for Caesarean
section: comparison of cyclizine, dexamethasone and placebo.
Br J Anaesth. 2003;90(5):665-70.
8. George RB, Allen TK, Habib AS. Serotonin receptor antagonists
for the prevention and treatment of pruritus, nausea, and
vomiting in women undergoing cesarean delivery with
intrathecal morphine: a systematic review and meta-analysis.
Anesth Analg. 2009;109(1):174-82.
9. Allen TK, Jones CA, Habib AS. Dexamethasone for the
prophylaxis of postoperative nausea and vomiting associated
with neuraxial morphine administration: a systematic review
and meta-analysis. Anesth Analg. 2012;114(4):813-22.
10. Griffiths JD, Gyte GML, Paranjothy S, Brown HC, Broughton HK,
Thomas J. Interventions for preventing nausea and vomiting in
women undergoing regional anaesthesia for caesarean section.
Cochrane Database Syst Rev. 2012;12(9):CD007579.
11. Peixoto AJ, Celich MF, Zardo L, Peixoto Filho AJ. Ondansetron
or droperidol for prophylaxis of nausea and vomiting after
intrathecal morphine. Eur J Anaesthesiol. 2006;23(8):670-5.
12. Royal College of Obstetricians and Gynaecologists, Royal College
of Anaesthetists. Classification of Urgency of Caesarean Section –
a continuum of Risk (Good Practice No. 11). RCOG. 2010.
13. Chattopadhyay S, Goswami S. Palonosetron Versus Ramosetron
Prophylaxis for Control of Postoperative Nausea and Vomiting
after Cesarean Delivery under Spinal Anesthesia. J Obstet
Gynaecol India. 2015;65(1):28-33.
14. Harnett MJ, O’Rourke N, Walsh M, Carabuena JM, Segal
S. Transdermal scopolamine for prevention of intrathecal
morphine-induced nausea and vomiting after cesarean delivery.
Anesth Analg. 2007;105(3):764-9.
15. Dominguez JE, Habib AS. Prophylaxis and treatment of the
side-effects of neuraxial morphine analgesia following cesarean
delivery. Curr Opin Anaesthesiol. 2013;26(3):288-95.
16. Iqbal IM, Spencer R. Postoperative nausea and vomiting. Anaesth
Intensive Care Med. 2012;13(12):613-6.
17. Horn CC, Wallisch WJ, Homanics GE, Williams JP.
Pathophysiological and neurochemical mechanisms of
postoperative nausea and vomiting. Eur J Pharmacol. 2014;
722(1):55–66.
18. Balki M, Carvalho JC. Intraoperative nausea and vomiting during
cesarean section under regional anesthesia. Int J Obstet Anesth.
2005;14(3):230–41.
19. Wu JI, Lo Y, Chia YY, Liu K, Fong WP, Yang LC, et al. Prevention
of postoperative nausea and vomiting after intrathecal
morphine for cesarean section: a randomized comparison of
dexamethasone, droperidol, and a combination. Int J Obstet
Anesth. 2007;16(2):122–7.
20. Cardoso MM, Leite AO, Santos EA, Gozzani JL, Mathias LA.
Effect of dexamethasone on prevention of postoperative nausea,
vomiting and pain after caesarean section: a randomised,
placebo-controlled, double-blind trial. Eur J Anaesthesiol.
2013;30(3):102–5.
21. Girgin NK, Gurbet A, Turker G, Aksu H, Gulhan N. Intrathecal
morphine in anesthesia for cesarean delivery: dose-response
relationship for combinations of low-dose intrathecal morphine
and spinal bupivacaine. J Clin Anesth. 2008;20(3):180–5.
22. Carvalho FA, Tenório SB. Comparative study between doses of
intrathecal morphine for analgesia after caesarean. Brazilian J
Anesthesiol. 2013;63(6):492–9.
23. Borgeat A, Ekatodramis G, Schenker C. Postoperative nausea
and vomiting in regional anesthesia: a review. Anesthesiology.
2003;(2):530–47.
24. Imeh A, Olaniyi O, Simeon O, Omotola O. Dexamethasone
versus a combination of dexamethasone and ondansetron
as prophylactic antiemetic in patients receiving intrathecal
morphine for caesarean section. Afr Health Sci. 2014;14(2):453–9.
25. Kung AT, Yang X, Li Y, Vasudevan A, Pratt S, Hess P. Prevention
versus treatment of intrathecal morphine-induced pruritus with
ondansetron. Int J Obstet Anesth. 2014;23(3):222–6.
26. 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(1):58–74.
27. García Márquez MJ, García Corzo CM. Náusea y vómito
secundarios a la limpieza peritoneal en cesárea bajo anestesia
subaracnoidea. Eficacia de la asociación fentanyl-midazolam.
Ensayo Clínico Controlado. Rev Colomb Anestesiol.
2007;35(1):29–35.
28. Meléndez Flórez HJ, Gamarra HG, Fernández C, Dulcey R.
Eficacia del fentanyl adicionado a bupivacaina en el dolor
intraoperatorio en cesárea bajo anestesia subaracnoidea. Ensayo
clínico controlado. Rev Colomb Anestesiol. 2005;33(3):161–8.
29. Manullang TR, Viscomi CM, Pace NL. Intrathecal fentanyl
is superior to intravenous ondansetron for the prevention of
perioperative nausea during cesarean delivery with spinal
anesthesia. Anesth Analg. 2000;90(5):1162–6.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2018 Revista Médicas UIS
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