Prevention of postoperative nausea and vomiting after intrathecal morphine for Cesarean section: a randomized comparison of dexamethasone, droperidol, and a combination.
BACKGROUND
Intrathecal morphine provides good analgesia after cesarean delivery but the side effects include nausea and vomiting. Low-dose droperidol (0.625 mg) combined with dexamethasone 4 mg is postulated to have an additive antiemetic effect with less side effects. We therefore compared single doses of dexamethasone and droperidol alone with a low-dose combination of the two, to prevent spinal morphine-induced nausea and vomiting after cesarean section.


METHODS
In a double-blind study, 120 women undergoing elective cesarean section under spinal anesthesia (using 0.5% bupivacaine 10 mg and morphine 0.2 mg) were allocated randomly to receive dexamethasone 8 mg, droperidol 1.25 mg, dexamethasone 4 mg and droperidol 0.625 mg, or placebo, before the end of surgery. The incidences of nausea and vomiting, sedative score, pain score, and side effects were recorded.


RESULTS
The incidence of nausea and vomiting within 6 h postoperatively was lower and incidence of no nausea and vomiting for 24 h postoperatively was significantly higher for the combination group compared to the placebo group and the dexamethasone only group. Sedation scores within 3 h postoperatively and incidence of restlessness for the combination group were significantly lower than in the droperidol only group.


CONCLUSIONS
An additive antiemetic effect and no significant side effects were shown for the combination of dexamethasone 4 mg and droperidol 0.625 mg. This combination was more effective than either dexamethasone 8 mg or droperidol 1.25 mg alone in preventing nausea and vomiting after spinal anesthesia using 0.5% bupivacaine and morphine 0.2 mg.
Wu
J I
JI
Department of Anesthesiology, Kaohsiung Municipal Min-Sheng Hospital, National Yang-Ming University School of Medicine, Taiwan, ROC.
Lo
Y
Y
Chia
Y Y
YY
Liu
K
K
Fong
W P
WP
Yang
L C
LC
Tan
P H
PH
D000328:Adult; D016362:Analgesia, Obstetrical / Q000379:methods*; D000701:Analgesics, Opioid / Q000009:adverse effects; D000932:Antiemetics / Q000627:therapeutic use; D002045:Bupivacaine; D002585:Cesarean Section / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D004329:Droperidol / Q000627:therapeutic use*; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D010147:Pain Measurement / Q000379:methods; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000517:prevention & control*; D011247:Pregnancy; D011446:Prospective Studies
D000701:Analgesics, Opioid; D000932:Antiemetics; D009020:Morphine; D003907:Dexamethasone; D004329:Droperidol; D002045:Bupivacaine