Control of nausea and vomiting in women undergoing cesarean section with spinal anesthesia: A narrative review study on the role of drugs

Document Type : Review Article

Authors

1 M.Sc. of Neonatal Intensive Care, Hazrate Fatemeh School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.

2 Assistant professor, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

3 Associate professor, Department of Anesthesiology and Intensive Care, Anesthesiology & Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.

4 Assistant professor, Department of Anesthesiology and Intensive Care, Anesthesiology and Pain Management Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.

5 Assistant professor, Department of Surgery, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.

6 Assistant professor, Department of Obstetrics and Gynecology, Women's Health and Diseases Research Center, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.

7 Instructor, Department of Anesthesia, Research Center for Social Determinants of Health, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.

8 Assistant Professor, Department of Pharmacology, Faculty of Medicine, Guilan University of Medical Sciences, Guilan, Iran.

9 Medical Student, Student Research Committee, Faculty of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.

10 Assistant professor, Department of Anesthesiology and Intensive Care, Anesthesiology & Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.

Abstract

Introduction: Spinal anesthesia is the most common method of analgesia for elective cesarean section. Postoperative nausea and vomiting is one of the most common complaints of patients in cesarean section under spinal anesthesia, so this study was performed with aim to investigate the role of drugs in controlling nausea and vomiting in women undergoing cesarean section with spinal anesthesia.
Methods: In this narrative review study, to find the related articles, databases of SID, Magiran, and Google Scholar were searched with the keywords of spinal anesthesia, nausea, vomiting, and cesarean section. The time period for searching articles was from 2001 to 2021.
Results: Different studies have used different medications to prevent nausea and vomiting after cesarean section. Nausea and vomiting after spinal anesthesia has been the specific goal of many studies with clinical trial design. The performed interventions in this regard included: use of drugs such as Dexamethasone, Ketamine, Lidocaine, Ondansetron, Metoclopramide, Granistron, Propofol, Gabapentin and Midazolam.
Conclusion: Although the anti-nausea and anti-emetic effect of ketamine has been approved in the studies, it is best not to be the first choice of an anesthesiologist because of the effects of hallucinations and nystagmus and the fact that it may delay breastfeeding. Propofol has also been shown to have anti-nausea and anti-emetic effects, but we must be careful about the effects of the patient's respiratory depression. Dexamethasone has a delaying effect on nausea and vomiting, so it may not be a good choice for an anesthesiologist. 5-HT3 receptor antagonists (ondansetron and granisetron) seem to be the best choice for first-line treatment of nausea and vomiting. Because these drugs do not have the extrapyramidal side effects of metoclopyramide and can be used as appropriate drugs for nausea and vomiting in patients undergoing cesarean section with spinal anesthesia.

Keywords

References

  1. Birnbach DJ, Browne IM. Anesthesia for obstetrics. In: Miller RD. Anesthesia. 6nd Philadelphia: Elsevier/Churchill Livingstone; 2005.
  2. Juhani TP, Hannele H. Complications during spinal anesthesia for cesarean delivery: a clinical report of one year's experience. Reg Anesth 1993; 18(2):128-31.
  3. Jabalameli M, Honarmand A, Safavi M, Chitsaz M. Treatment of postoperative nausea and vomiting after spinal anesthesia for cesarean delivery: A randomized, double-blinded comparison of midazolam, ondansetron, and a combination. Advanced biomedical research 2012; 1:2.
  4. Rabey PG, Smith G. Anaesthetic factors contributing to postoperative nausea and vomiting. British Journal of Anaesthesia 1992; 69:40S-5S.
  5. Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. The Journal of the American Society of Anesthesiologists 1999; 91(3):693-700.
  6. Gan TJ. Risk factors for postoperative nausea and vomiting. Anesthesia & Analgesia 2006; 102(6):1884-98.
  7. 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. Anesthesia & Analgesia 2000; 90(5):1162-6.
  8. Borgeat A, Ekatodramis G, Schenker CA. Postoperative nausea and vomiting in regional anesthesia: a review. The Journal of the American Society of Anesthesiologists 2003; 98(2):530-47.
  9. Elhakim M, Ali NM, Rashed I, Riad MK, Refat M. Dexamethasone reduces postoperative vomiting and pain after pediatric tonsillectomy. Canadian Journal of Anesthesia 2003; 50(4):392-7.
  10. Henzi I, Walder B, Tramer MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesthesia & Analgesia 2000; 90(1):186-94.
  11. Miller RD. Anesthesia. 6nd Philadelphia: Elsevier/Churchill Livingstone; 2005. p.2328-9.
  12. Eltringham RJ, Cacey WF, Durkin M. Post-Operative Recovery and Pain Relief. 1nd Springer-Verlag London; 1998. P. 77-8.
  13. Fujii Y. Retraction Notice: Prevention of emetic episodes during cesarean delivery performed under regional anesthesia in parturients. Current drug safety 2007; 2(1):25-32.
  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. Anesthesia & Analgesia 2007; 105(3):764-9.
  15. Bahmani H, Sadeghi E, Hosseinipanah L. Comparison of prophylactic antiemetic effect of ondansetron, dexamethasone and metoclopramide in cesarean delivery under general Anesthesia. J Isfahan Med Sch 2015; 33(330): 505-14
  16. Voigt M, Fröhlich CW, Hüttel C, Kranke P, Mennen J, Boessneck O, et al. Prophylaxis of intra-and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia. Medical science monitor: international medical journal of experimental and clinical research 2013; 19:993-1000.
  17. Kalani N, Zabetian H, Sanie MS, Deylami M, Radmehr M, Sahraei R, et al. The effect of ondansetron and dexamethasone on nausea and vomiting under spinal anesthesia. World journal of plastic surgery 2017; 6(1):88-93.
  18. Wang JJ, Ho ST, Liu YH, Lee SC, Liu YC, Liao YC, et al. Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy. British journal of anaesthesia 1999; 83(5):772-5.
  19. Wang JJ, Ho ST, Uen YH, Lin MT, Chen KT, Huang JC, et al. Small-dose dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy: a comparison of tropisetron with saline. Anesthesia & Analgesia 2002; 95(1):229-32.
  20. Banihashem N, Hassannasab B, Naziri F, Rahimifar AR, Hosseini V, Shirkhani Z. Comparison of the prophylactic effect of ondansetron and dexamethasone on postoperative nausea and vomiting after intrathecal meperidine in women scheduled for elective cesarean section. Journal of Babol University of Medical Sciences 2011; 13(3):29-33.
  21. 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. European Journal of Anaesthesiology 2013; 30(3):102-5.
  22. Dal D, Kose A, Honca M, Akinci SB, Basgul E, Aypar U. Efficacy of prophylactic ketamine in preventing postoperative shivering. British journal of anaesthesia 2005; 95(2):189-92.
  23. Kovac AL. Prevention and treatment of postoperative nausea and vomiting Drugs. 2000; 59(2):213-43.
  24. Sherwood ER, Williams CG, Prough DS. Anesthesiology Principles, Pain Management, and Conscious Sedation. Sabiston Textbook of Surgery (Sabiston Textbook of Surgery: The Biological Basis of Modern Practicsurgical Practice). 17nd Philadelphia: Saunders; 2004. p. 434.
  25. Morgan GE, Mikhail MS, Murray MJ, Larson CP. Clinical anesthesiology. 4nd New York: Lange Medical Books/McGraw-Hill; 2006.
  26. Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL. Miller’s Anesthesia. 8nd USA. Philadelphia, Elsevier; 2015.
  27. Rahmanian M, Leysi M, Hemmati AA, Mirmohammadkhani M. The effect of low-dose intravenous ketamine on postoperative pain following cesarean section with spinal anesthesia: a randomized clinical trial. Oman medical journal 2015; 30(1):11-16.
  28. Hassanein A, Mahmoud E. Effect of low dose ketamine versus dexamethasone on intraoperative nausea and vomiting during cesarean section under spinal anesthesia. Egyptian Journal of Anaesthesia 2015; 31(1):59-63.
  29. Akhavanakbari G, Ghazi A, Emami S. A comparative study on effect of low dose Ketamine versus Dexamethasone on intraoperative nausea and vomiting during cesarean section under spinal anesthesia. J. Anesthesiol. Pain. 2020 Jan 1;11(2):1-13.
  30. Shabana AM, Nasr ES, Moawad HE. Effect of ketamine on intraoperative nausea and vomiting during elective caesarean section under spinal anaesthesia: A placebo-controlled prospective randomized double blinded study. Egyptian Journal of Anaesthesia 2012; 28(2):169-74.
  31. Foroughian M, Abiri S, Akbari H, Shayesteh Bilandi V, Habibzadeh SR, Alsana F, et al. Effectiveness of intravenous lidocaine versus intravenous morphine in reducing acute extremity trauma-induced pain: A triple-blind randomized clinical trial. Koomesh 2020; 22(3):411-8.
  32. Vanstone RJ, Rockett M. Use of atypical analgesics by intravenous infusion (IV) for acute pain: evidence base for lidocaine, ketamine and magnesium. Anaesthesia & Intensive Care Medicine 2016; 17(9):460-3.
  33. Grekin RC, Auletta MJ. Local anesthesia in dermatologic surgery. Journal of the American Academy of Dermatology 1988; 19(4):599-614.
  34. Buchsbaum GM, Albushies DT, Schoenecker E, Duecy EE, Glantz JC. Local anesthesia with sedation for vaginal reconstructive surgery. International Urogynecology Journal 2006; 17(3):211-4.
  35. Zohar E, Shapiro A, Phillipov A, Hoppenstein D, Klein Z, Fredman B. The postoperative analgesic efficacy of wound instillation with ropivacaine 0.1% versus ropivacaine 0.2%. Journal of clinical anesthesia 2004; 16(6):399-404.
  36. Zohar E, Fredman B, Phillipov A, Jedeikin R, Shapiro A. The analgesic efficacy of patient-controlled bupivacaine wound instillation after total abdominal hysterectomy with bilateral salpingo-oophorectomy. Anesthesia & Analgesia 2001; 93(2):482-7.
  37. Zohar E, Luban I, Zunser I, Shapiro A, Jedeikin R, Fredman B. Patient-controlled bupivacaine wound instillation following cesarean section: the lack of efficacy of adjuvant ketamine. Journal of clinical anesthesia 2002; 14(7):505-11.
  38. Bameshki SA, Zirak N, Ghuriani H, Fathi M. The incidence of hypotension, nausea and vomiting after spinal anesthesia for elective caesarean section: a comparison between bupivacaine 0.5% and lidocaine 5%. Journal Of Anesthesiology And Pain (Persian) WINER 2013; 3(2):119-24.
  39. Hesketh PJ. Clinical science review: comparative review of 5-HT3 receptor antagonists in the treatment of acute chemotherapy-induced nausea and vomiting. Cancer investigation 2000; 18(2):163-73.
  40. Leeser J, Lip H. Prevention of postoperative nausea and vomiting using ondansetron, a new, selective, 5-HT3 receptor antagonist. Anesthesia and analgesia 1991; 72(6):751-5.
  41. Scuderi P, Wetchler B, Sung YF, Mingus M, DuPen S, Claybon L, et al. Treatment of postoperative nausea and vomiting after outpatient surgery with the 5-HT3 antagonist ondansetron. The Journal of the American Society of Anesthesiologists 1993; 78(1):15-20.
  42. Wang SC, Borison HL. The vomiting center: a critical experimental analysis. Archives of Neurology & Psychiatry 1950; 63(6):928-41.
  43. Nichols DE, Nichols CD. Serotonin receptors. Chem Rey 2008; 108(5):1614-41.
  44. Antonetti M, Kirton O, Bui P, Ademi A, Staff I, Hudson-Civetta JA, et al. The effects of preoperative rofecoxib, metoclopramide, dexamethasone, and ondansetron on postoperative pain and nausea in patients undergoing elective laparoscopic cholecystectomy. Surgical endoscopy 2007; 21(10):1855-61.
  45. Jamilian M. Comparison of the Effect of Ginger, Gabapentin, and Ondansetron For Prevention of Nausea And Vomiting After Cesarean Section By Spinal Anesthesia. Complementary Medicine Journal of Faculty of Nursing & Midwifery 2015; 5(2):1123-32.
  46. Norouzi A, Jamilian M, Khalili M, Kamali A, Melikof L. Comparison of the effect of oral and intravenous ondansetron on decreasing nausea and vomiting after cesarean section. Journal of Arak University of Medical Sciences 2013; 16(5):100-7.
  47. White PF, Freire AR. Ambulatory (outpatient) anesthesia: Anesthesia. Miller's Anesthesia. 6nd Philadelphia: Churchill Livingstone; 2005:2598-9.
  48. Malekshoar M, Jarineshin H, Kalani N, Vatankhah M. Comparing the effect of metoclopramide and promethazine on preventing nausea and vomiting after laparoscopic cholecystectomy: A double-blind clinical trial. Koomesh 2021; 23(2):203-10.
  49. Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, Rauch S, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. British journal of anaesthesia 2002; 88(5):659-68.
  50. Watcha MF, White PF. Postoperative nausea and vomiting: its etiology, treatment, and prevention. The Journal of the American Society of Anesthesiologists 1992; 77(1):162-84.
  51. Pazouki S, Eskandari M, Memari S, Norouzi A, Zargangfar A. The effectiveness of Metoclopramide, Dexamethasone and Propofol in controlling intraoperative nausea and vomiting during spinal anesthesia for emergency cesarean section. Journal of Arak University of Medical Sciences 2006; 9(3):9-15.
  52. Zahedi H, Rouzbeh Kargar L. Comparing the prophylaxis effect of Ondansetron and Metoclopramide against intraoperative nausea and vomiting during spinal anesthesia for cesarean section. Journal of Babol University of Medical Sciences 2004; 6(3):32-6.
  53. Sane S, Mahoori A, Abbasi Vash R, Rezai H, Fazlifard S. Effects of granisetron on pruritus, nausea, and vomiting induced by intrathecal opioid in cesarean section under spinal anesthesia. Journal of Mazandaran University of Medical Sciences 2017; 27(147):150-8.
  54. Safaeian R, Salehi N, Tamadon Rastegar M. Comparison between Two Drug Combination Effects on Post-Operative Nausea and Vomiting in Abdominal Operations (Granisetron & Dexamethasone VS Droperidol & Dexamethasone). Razi Journal of Medical Sciences 2005; 11(44):987-92.
  55. Wilson AJ, Diemunsch P, Lindeque BG, Scheinin H, Helbo-Hansen HS, Kroeks MV, et al. Single-dose i.v. granisetron in the prevention of postoperative nausea and vomiting. Br J Anaesth 1996; 76(4):515-8.
  56. Gan TJ, Coop A, Philip BK, Kytril Study Group. A randomized, double-blind study of granisetron plus dexamethasone versus ondansetron plus dexamethasone to prevent postoperative nausea and vomiting in patients undergoing abdominal hysterectomy. Anesthesia & Analgesia 2005; 101(5):1323-9.
  57. Beyzai H, hozhabrosadat Y, Maghferati V, Raisi M. Comparison of intravenous Ondansetron and Granisetron in prevention of Post Cesarean section operation Nausea and Vomiting in 22 Bahman Hospital of Mashhad Islamic Azad university 2014; 4(2):1-16.
  58. Visser K, Hassink EA, Bonsel GJ, Moen J, Kalkman CJ. Randomized controlled trial of total intravenous anesthesia with propofol versus inhalation anesthesia with isoflurane–nitrous oxide: postoperative nausea and vomiting and economic analysis. The Journal of the American Society of Anesthesiologists 2001; 95(3):616-26.
  59. Kotani Y, Shimazawa M, Yoshimura S, Iwama T, Hara H. The experimental and clinical pharmacology of propofol, an anesthetic agent with neuroprotective properties. CNS neuroscience & therapeutics 2008; 14(2):95-106.
  60. Roussin A, Montastruc JL, Lapeyre‐Mestre M. Pharmacological and clinical evidences on the potential for abuse and dependence of propofol: a review of the literature. Fundamental & clinical pharmacology 2007; 21(5):459-66.
  61. Carlisle J, Stevenson CA. Drugs for preventing postoperative nausea and vomiting. The Cochrane Library; 2006.
  62. Roberts GW, Bekker TB, Carlsen HH, Moffatt CH, Slattery PJ, McClure AF. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesthesia & Analgesia 2005; 101(5):1343-8.
  63. Vatankhah M, Sadeghi SE, Zarenezhad M, Rasekh Jahromi A, Kalani N, Hatami N, et al. Low doses of propofol and midazolam on maternal hemodynamic symptoms and neonatal Apgar in women undergoing spinal anesthesia in cesarean section: A double-blind randomized clinical trial study. Iran J Obstet Gynecol Infertil 2021 ;24(2):41-9.
  64. Khezri MB, Reshad F, Javadi A. Comparison of Metoclopramide and low dose Propofol for prophylaxis of nausea & vomiting after cesarean section. J Birjand Univ Med Sci 2009; 16(3):5-8.
  65. Mortazavi Y, Alijanpour E, Rabiei O, Haj AM. Effect of Metoclopramide and Propofol plus Dexamethasone on Postoperative Nausea and Vomiting In Patients under Spinal. Journal of Babol University of Medical Sciences (JBUMS) 2008; 10(4):24-29.
  66. Kukkar A, Bali A, Singh N, Jaggi AS. Implications and mechanism of action of gabapentin in neuropathic pain. Archives of pharmacal research 2013; 36(3):237-51.
  67. Bang SR, Yu SK, Kim TH. Can gabapentin help reduce postoperative pain in arthroscopic rotator cuff repair? A prospective, randomized, double-blind study. Arthroscopy: The Journal of Arthroscopic & Related Surgery 2010; 26(9):S106-11.
  68. Katzung BG, Masters S, Trevor AJ. Basic and Clinical Pharmacology. 9nd Lange Medical Books; 2002.
  69. Pandey CK, Priye S, Ambesh SP, Singh S, Singh U, Singh PK. Prophylactic gabapentin for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study. Journal of postgraduate medicine 2006; 52(2):97-100.
  70. Koç S, Memis D, Sut N. The preoperative use of gabapentin, dexamethasone, and their combination in varicocele surgery: a randomized controlled trial. Anesthesia & Analgesia 2007; 105(4):1137-42.
  71. Memari F, Jadidi R, Noroozi A, Mohammadbeigi A, Falahati J. Protecting effect of gabapentin for nausea and vomiting in the surgery of cesarean after spinal anesthesia. Anesthesia, essays and researches 2015; 9(3):401-4.
  72. Asadi Louyeh A. The Comparison of Midazolam and Diazepam on Incidence of Postoperative Nausea and vomiting. Journal of Guilan University of Medical Sciences 2001; 10(39):112-8.
  73. Allonen H, Ziegler G, Klotz U. Midazolam kinetics. Clinical Pharmacology & Therapeutics 1981; 30(5):653-61.
  74. Greenblatt DJ, Divoll M, Abernethy DR, Locniskar A, Shader RI. Pharmacokinetics of benzodiazepine hypnotics. Pharmacology 1983; 27(Suppl. 2):70-5.
  75. Sane S, Mahoori A, Karami N, Rezaei H, Rezapoure M. Comparison of The Effectiveness of Intravenous Midazolam With Ondansetron on Nausea and Vomiting in Cesarean Sections With Spinal Anesthesia. Studies in Medical Sciences 2017; 28(3):155-62.
  76. Khalil S, Philbrook L, Rabb M, Wells L, Aves T, Villanueva G, et al. Ondansetron/promethazine combination or promethazine alone reduces nausea and vomiting after middle ear surgery. Journal of clinical anesthesia 1999; 11(7):596-600.
  77. Phillis JW, Bender AS, Wu PH. Benzodiazepines inhibit adenosine uptake into rat brain synaptosomes. Brain Research 1980; 195(2):494-8.
  78. Takada K, Murai T, Kanayama T, Koshikawa N. Effects of midazolam and flunitrazepam on the release of dopamine from rat striatum measured by in vivo microdialysis. BJA: British Journal of Anaesthesia 1993; 70(2):181-5.
  79. Florio TD. The use of midazolam for persistent postoperative nausea and vomiting. Anaesthesia and intensive care 1992; 20(3):383-6.
  80. Crowe S. Midazolam–an anti‐emetic?. Anaesthesia 2002; 57(8):818-38.
  81. Bauer KP, Dom PM, Ramirez AM, O'Flaherty JE. Preoperative intravenous midazolam: benefits beyond anxiolysis. Journal of clinical anesthesia 2004; 16(3):177-83.
  82. Rasooli S, Moslemi F, Khaki A. Effect of sub hypnotic doses of propofol and midazolam for nausea and vomiting during spinal anesthesia for cesarean section. Anesthesiology and pain medicine 2014; 4(4):e19384..
  83. Hu B, Zhou H, Zou X, Shi J, Li X, Tan L. A Comparison of Dexmedetomidine and Midazolam for the Prevention of Postoperative Nausea and Vomiting Caused by Hemabate in Cesarean Delivery: A Randomized Controlled Trial. Drug design, development and therapy 2020; 14:2127-33.
  84. Tarhan Ö, Canbay Ö, Celebi N, Uzun S, Sahin A, Coşkun F, et al. Subhypnotic doses of midazolam prevent nausea and vomiting during spinal anesthesia for cesarean section. Minerva anestesiologica 2007; 73(12):629-33.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 24, Issue 7
September 2021
Pages 98-107

Files

Share

How to cite

Statistics