Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo.
BACKGROUND
Low-dose intrathecal (spinal) morphine (0.1-0.2 mg) for Caesarean section delivers excellent postoperative analgesia but is associated with significant nausea and vomiting. We compared the antiemetic efficacy of cyclizine, dexamethasone, and placebo in this clinical setting.


METHODS
Ninety-nine women undergoing elective Caesarean section under spinal anaesthesia were allocated randomly, in a double-blind study design, to receive either cyclizine 50 mg, dexamethasone 8 mg, or placebo as a single-dose infusion in saline 0.9%, 100 ml on completion of surgery. Spinal anaesthesia consisted of: hyperbaric bupivacaine 0.5%, 2.0 ml; fentanyl 10 micro g; and spinal morphine 0.2 mg. The primary outcome measure was the incidence of nausea.


RESULTS
The incidence of nausea was significantly less in patients receiving cyclizine compared with dexamethasone and placebo (33 vs 60 and 67%, respectively, P<0.05). Severity of nausea and number of vomiting episodes were also less at 3-6 h in cyclizine patients. Overall satisfaction with postoperative care at 24 h, expressed on a 100 mm visual analogue scale, was greater in cyclizine [78 (28)] than either dexamethasone [58 (31), P=0.03] or placebo [51 (28), P=0.008].


CONCLUSIONS
We conclude that following spinal morphine 0.2 mg and fentanyl 10 micro g analgesia for Caesarean section, cyclizine 50 mg i.v. reduces the incidence of nausea compared with dexamethasone 8 mg i.v. or placebo. It also lessens the severity of nausea and vomiting, and increases maternal satisfaction in the early postoperative period.
Nortcliffe
S-A
SA
University Department of Anaesthesia, Critical Care and Pain Management, Leicester University, University Hospitals of Leicester NHS Trust, Leicester General Hospital, UK.
Shah
J
J
Buggy
D J
DJ
D000328:Adult; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000009:adverse effects; D000773:Anesthesia, Obstetrical; D000775:Anesthesia, Spinal; D000932:Antiemetics / Q000627:therapeutic use*; D002585:Cesarean Section; D003501:Cyclizine / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D009020:Morphine / Q000009:adverse effects; D017060:Patient Satisfaction; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000517:prevention & control*; D011247:Pregnancy; D012720:Severity of Illness Index
D000701:Analgesics, Opioid; D000932:Antiemetics; D009020:Morphine; D003907:Dexamethasone; D003501:Cyclizine