Antiemetic prophylaxis during elective Caesarean section under spinal anaesthesia: Comparison of Cyclizine, Metocloparide and placebo
BACKGROUND: Emetic symptoms are frequent and undesirable perioperative events in patients undergoing caesarean delivery under spinal anaesthesia. Many drugs have been tried, with varying degrees of successes in preventing intraoperative nausea and vomiting. These symptoms are distressing to patients intraoperatively and in the postoperative period, hence prophylaxis is recommended.
PATIENTS AND METHODS: This was a prospective, randomized, double-blinded, placebo-controlled study comparing the effectiveness of single dose intravenous cyclizine, metoclopramide, and placebo in preventing emetic symptoms among parturient undergoing caesarean section under spinal anaesthesia. Each of the 116 parturient of American Society of Anesthesiologist (ASA) I-II undergoing elective caesarean section under spinal anaesthesia was randomly allocated into three groups: 39 patients in group I, 39 patients in group II, and 38 patients in group III. Before establishing spinal anaesthesia, patients in group I were given 2 ml of 0.9% saline intravenously, patients in group II were given 10 mg of metoclopramide in 2 ml intravenously, while those in group III were given 50 mg of cyclizine diluted with water for injection to 2 ml and given intravenously. Patients were monitored and records of emetic symptoms, vital signs and side effects of drugs were documented. Neonatal APGAR scores were also recorded.
RESULTS: Emetic symptoms experienced intraoperatively were nausea, retching and vomiting. Nausea occurred in 14(35.9%) patients in group I, 6(15.4%) patients in group II and 1(2.6%) patient in group III, P = 0.001. Retching occurred in 7(17.9%) patients in group I, 2(5.1%) patients in group II and none in group III, with a P = 0.010. Vomiting occurred in 5(12.8%) patients in group I, 2(5.1%) patients in group II and none in group III, P = 0.059. 4(10.3%) patients had severe nausea in group I, 3(7.7%) patients in group II, and none in group III, P = 0.017. Use of rescue antiemetics was similarly less in group III, P = 0.006. Sedation was associated more with group III, P = 0.001, but no respiratory depression. Also newborn APGAR scores were similar, and no signs of depression recorded among the babies delivered by the patients in any of the groups.
CONCLUSION: Cyclizine is superior to metoclopramide in preventing nausea and vomiting in women undergoing caesarean section under spinal anaesthesia.