Comparing the efficacy of prophylactic metoclopramide, ondansetron, and placebo in cesarean section patients given epidural anesthesia

• Published in: Journal of clinical anesthesia Vol. 13; no. 6; pp. 430 - 435
• Main Authors: PAN, Peter H, MOORE, Charles H
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Science 01.09.2001
• Subjects: Adult; Anesthesia, Epidural - adverse effects; Anesthesia, Obstetrical - adverse effects; Antiemetics - therapeutic use; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Cesarean Section; Double-Blind Method; Female; Humans; Medical sciences; Metoclopramide - adverse effects; Metoclopramide - therapeutic use; Ondansetron - adverse effects; Ondansetron - therapeutic use; Pharmacology. Drug treatments; Postoperative Nausea and Vomiting - prevention & control; Pregnancy; Human; Postoperative; Nausea; Metoclopramide; Prevention; Chemotherapy; Vomiting; Surgery; 5-HT3 Serotonine receptor; Digestive diseases; Benzamide derivatives; Complication; Female; Delivery; Antagonist; Antiemetic; Cesarean section; Comparative study; Ondansetron
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/S0952-8180(01)00294-X

To compare the relative efficacy of prophylactic metoclopramide, ondansetron, and placebo in nonemergent cesarean section patients given epidural anesthesia intraoperatively and for the first 24-hour period after delivery. Randomized, double blind, placebo-controlled study. Inpatient obstetric unit at a university hospital center. 164 nonemergent cesarean section patients given epidural anesthesia. At time of umbilical cord clamp, patients received intravenously (IV) either 4 mg ondansetron (Group O) or 10 mg metoclopramide (Group M) or 10 mL normal saline (Group P). Episodes and severity of nausea and vomiting, rescue antiemetic requirement, patient satisfaction, and side effects were recorded. The frequency of intraoperative nausea were 24%, 43%, and 57% for Group O, Group M, and Group P, respectively (p < 0.03). The frequency of nausea for the 24-hour study period were 26%, 51% and 71% for Groups O, M, and P respectively (p < 0.03). The frequency of intraoperative and postoperative vomiting were similar between Group O and Group M, but significantly higher in Group P (p < 0.05). Overall patient satisfaction was highest in Group O compared with Groups P and M (p < 0.05). Maximum analog sedation score was higher in Group M compared to Groups O and P (p < 0.05). In cesarean section patients given epidural anesthesia, prophylactic ondansetron, 4 mg IV, is more efficacious and has a higher patient satisfaction than that with metoclopramide, 10 mg IV, or placebo in preventing nausea and achieving complete responses during intraoperative period and the first 24-hour postdelivery period. However, there is no difference between ondansetron and metoclopramide in reducing frequency of vomiting. Prophylactic ondansetron 4 mg IV is more effective in preventing nausea than vomiting.