title: Intrathecal atropine to prevent postoperative nausea and vomiting after Cesarean section: a randomized, controlled trial.
abstract: BACKGROUND
  Postoperative nausea and vomiting (PONV) is a common adverse effect of intrathecal morphine, especially after Cesarean section. This randomized controlled trial investigated the effects of intrathecal administration of a small-dose of atropine on postoperative nausea and vomiting after Cesarean section.
  
  
  METHODS
  Parturients with ASA physical status class I-II scheduled for elective Cesarean section and consenting to spinal anesthesia were enrolled. They received 0.5% hyperbaric bupivacaine 12.5 mg, morphine 200 µg and one of the following three solutions: atropine 100 µg intrathecally and saline intravenously; saline intrathecally and atropine 100 µg intravenously; saline only both intravenously and intrathecally. We examined the incidence and severity of PONV, pain ratings and the need for analgesics.
  
  
  RESULTS
  We followed 204 parturients. The incidence of PONV was 15%, 37% and 49% in the three groups, respectively (P<0.001). The relative risk reduction for PONV when using intrathecal atropine was 69% vs. placebo and 59% vs. intravenous atropine. No differences were noted in terms of postoperative pain.
  
  
  CONCLUSIONS
  Intrathecal atropine had a significant antiemetic effect, making it a useful adjunct for intrathecal opioid-related PONV.
authors: Department of Anesthesiology, Critical Care and Pain Medicine, University Hospital of Parma, Parma, Italy. mbaciarello@parmanesthesia.com
authors: M
authors: M
authors: Baciarello
authors: A
authors: A
authors: Cornini
authors: M
authors: M
authors: Zasa
authors: P
authors: P
authors: Pedrona
authors: G
authors: G
authors: Scrofani
authors: F S
authors: FS
authors: Venuti
authors: G
authors: G
authors: Fanelli
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000009:adverse effects*; D001285:Atropine / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002585:Cesarean Section; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007278:Injections, Spinal; D053208:Kaplan-Meier Estimate; D009020:Morphine / Q000009:adverse effects*; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control*; D011247:Pregnancy; D011537:Pruritus / Q000517:prevention & control; D018401:Sample Size
chemical_list: D000701:Analgesics, Opioid; D018727:Muscarinic Antagonists; D009020:Morphine; D001285:Atropine