Prevention of nausea and vomiting with granisetron, droperidol and metoclopramide during and after spinal anaesthesia for caesarean section: a randomized, double-blind, placebo-controlled trial.
BACKGROUND
Nausea and vomiting during and after spinal anaesthesia for caesarean section are distressing to the patient. This study was undertaken to evaluate the efficacy and safety of granisetron, droperidol and metoclopramide for the prevention of nausea and vomiting in parturients undergoing caesarean section under spinal anaesthesia.


METHODS
In a randomized, double-blind, placebo-controlled trial, 120 patients received granisetron 3 mg, droperidol 1.25 mg, metoclopramide 10 mg or placebo (saline) (n = 30 of each) i.v. immediately after clamping of the foetal umbilical cord. Nausea, vomiting and safety assessments were performed during and after spinal anaesthesia for caesarean section.


RESULTS
The incidence of intraoperative, post-delivery nausea and vomiting was 13%, 17%, 20% and 63% after administration of granisetron, droperidol, metoclopramide and placebo, respectively; the corresponding incidence during 0-3 h after surgery was 7%, 27%, 27% and 43%; the corresponding incidence during 3-24 h after surgery was 7%, 20%, 23% and 37% (P < 0.05; overall Fisher's exact probability test). No clinically important adverse events were observed in any of the groups.


CONCLUSIONS
Granisetron is highly effective for preventing nausea and vomiting during and after spinal anaesthesia for caesarean section. Droperidol and metoclopramide are effective for the prevention of intraoperative, post-delivery emesis, but are ineffective for the reduction of the incidence of postoperative emesis.
Department of Anaesthesiology, Toride Kyodo General Hospital, Ibaraki, Japan.
Y
Y
Fujii
H
H
Tanaka
H
H
Toyooka
D000328:Adult; D000775:Anesthesia, Spinal; D000932:Antiemetics / Q000009:adverse effects / Q000627:therapeutic use*; D002585:Cesarean Section; D004311:Double-Blind Method; D004329:Droperidol / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D017829:Granisetron / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008787:Metoclopramide / Q000009:adverse effects / Q000627:therapeutic use*; D010919:Placebos; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011247:Pregnancy
D000932:Antiemetics; D004329:Droperidol; D017829:Granisetron; D008787:Metoclopramide; D010919:Placebos