Evaluation of Efficacy of Metoclopramide, Dexamethasone and Their Combination for the Prevention of Postoperative Nausea and Vomiting (PONV) in Patients Undergoing Cesarean Section

Abstract

Background: Nausea and/or vomiting following regional anaesthesia in pregnant females undergoing caesarean section is a major clinical problem. This study was conducted to compared the efficacy of metoclopramide, dexamethasone, and their combination for preventing intra operative & post-operative nausea and vomiting (PONV) following spinal anaesthesia given for caesarean section in patients. Materials and Methods: A total of 120 full term pregnant females of ASA I & II grade with uncomplicated pregnancies were included in this prospective randomized double blind study. Patients were randomly allocated to three groups. The group D (n= 40) received 8 mg dexamethasone, group M (n=40) received10 mg of metoclopramide while group D+M (n= 40) received 8 mg dexamethasone along with10 mg of metoclopramide intravenously immediately before administration of spinal anaesthesia. Intraoperative and post operative emetic episodes (nausea, retching, and vomiting) was noted as well as any other adverse effects. Results: During intraoperative period all parturients had PONV score 0. Postoperatively at first hour number of full responders in group D, M and D+M were 29/40 (72.5%), 30/40 (75%), 38/40 (95%) and the difference was statistically significant (Group D Vs Group D+ M, P value -0.013 and Group M Vs Group D+ M, P value-0.025). At 3rd hour postoperatively 9 patients in Group D, 8 patients in Group M and 1 in Group D+ M, had PONV score 1 (Group D Vs Group D+ M, P value -0.014 and Group M Vs Group D+ M, P value-0.029). No patient had any vomiting episodes over the time period of 24 hrs. Conclusion: Combined use of dexamethasone and metoclopramide as a prophylactic antiemetic was significantly better for the prevention of PONV as compared to the use of dexamethasone and metoclopramide alone.