Prevention of nausea and vomiting in caesarean section under spinal anaesthesia with midazolam or metoclopramide?

Abstract

OBJECTIVE:

To evaluate the efficacy and safety of bolus dose of midazolam and metoclopramide in reducing emetic symptoms during caesarean delivery under spinal anaesthesia.

METHODS:

In a double-blind study, 80 women undergoing elective caesarean section under spinal anaesthesia (using 0.5% bupivacaine 10 mg) were allocated randomly to receive midazolam 2 mg, or metoclopramide 10 mg at the beginning of surgery before skin incision. The frequency of nausea and vomiting, sedative score, respiratory depression, and side effects were recorded.

RESULTS:

The frequency of intraoperative nausea and vomiting was lower in the midazolam group compared with metoclopramide (15% versus 52.5%). Sedation scores within 3 hour postoperatively were significantly lower in the metoclopramide group. The frequency of respiratory depression was higher in midazolam group. There were some episodes of respiratory depression (respiratory rate of less than 10 bpm) in 17 patients in the midazolam group at the time of surgery treated by verbal stimulation, but no respiratory depression was seen in metoclopramide group. Neonatal outcome was similar in the two groups and all the neonates had Apgar scores > or = 8 at one and five minutes.

CONCLUSIONS:

A bolus dose of midazolam (2 mg) was more effective than metoclopramide (10 mg) for the prevention of nausea and vomiting in parturients patients undergoing caesarean section under spinal anaesthesia, however, further studies are needed to prove the safety of midazolam in parturient patients undergoing caesarean section.

• Authors: Ali Shahriari, Maryam Khooshideh, Mohamad Hassan Heidari
• Journal: JPMA. The Journal of the Pakistan Medical Association (J Pak Med Assoc) Vol. 59 Issue 11 Pg. 756-9 (Nov 2009) ISSN: 0030-9982 [Print] Pakistan
• PMID: 20361674 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Antiemetics
• Hypnotics and Sedatives
• Metoclopramide
• Midazolam

Topics

• Adolescent
• Adult
• Anesthesia, Spinal
• Antiemetics (therapeutic use)
• Cesarean Section
• Chi-Square Distribution
• Double-Blind Method
• Female
• Humans
• Hypnotics and Sedatives (therapeutic use)
• Metoclopramide (therapeutic use)
• Midazolam (therapeutic use)
• Postoperative Nausea and Vomiting (prevention & control)
• Pregnancy
• Pregnancy Outcome
• Prospective Studies
• Statistics, Nonparametric