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Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo.
Br J Anaesth. 2003 May; 90(5):665-70.BJ

Abstract

BACKGROUND

Low-dose intrathecal (spinal) morphine (0.1-0.2 mg) for Caesarean section delivers excellent postoperative analgesia but is associated with significant nausea and vomiting. We compared the antiemetic efficacy of cyclizine, dexamethasone, and placebo in this clinical setting.

METHODS

Ninety-nine women undergoing elective Caesarean section under spinal anaesthesia were allocated randomly, in a double-blind study design, to receive either cyclizine 50 mg, dexamethasone 8 mg, or placebo as a single-dose infusion in saline 0.9%, 100 ml on completion of surgery. Spinal anaesthesia consisted of: hyperbaric bupivacaine 0.5%, 2.0 ml; fentanyl 10 micro g; and spinal morphine 0.2 mg. The primary outcome measure was the incidence of nausea.

RESULTS

The incidence of nausea was significantly less in patients receiving cyclizine compared with dexamethasone and placebo (33 vs 60 and 67%, respectively, P<0.05). Severity of nausea and number of vomiting episodes were also less at 3-6 h in cyclizine patients. Overall satisfaction with postoperative care at 24 h, expressed on a 100 mm visual analogue scale, was greater in cyclizine [78 (28)] than either dexamethasone [58 (31), P=0.03] or placebo [51 (28), P=0.008].

CONCLUSION

We conclude that following spinal morphine 0.2 mg and fentanyl 10 micro g analgesia for Caesarean section, cyclizine 50 mg i.v. reduces the incidence of nausea compared with dexamethasone 8 mg i.v. or placebo. It also lessens the severity of nausea and vomiting, and increases maternal satisfaction in the early postoperative period.

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Authors+Show Affiliations

Nortcliffe SA
University Department of Anaesthesia, Critical Care and Pain Management, Leicester University, University Hospitals of Leicester NHS Trust, Leicester General Hospital, UK.
Shah J
No affiliation info available
Buggy DJ
No affiliation info available

MeSH

AdultAnalgesia, ObstetricalAnalgesics, OpioidAnesthesia, ObstetricalAnesthesia, SpinalAntiemeticsCesarean SectionCyclizineDexamethasoneDouble-Blind MethodFemaleHumansMorphinePatient SatisfactionPostoperative Nausea and VomitingPregnancySeverity of Illness Index

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12697596

Clinical Trial Links

Spinal Morphine vs. Hydromorphone for Pain Control After Cesarean Delivery

Citation

Nortcliffe, S-A, et al. "Prevention of Postoperative Nausea and Vomiting After Spinal Morphine for Caesarean Section: Comparison of Cyclizine, Dexamethasone and Placebo." British Journal of Anaesthesia, vol. 90, no. 5, 2003, pp. 665-70.
Nortcliffe SA, Shah J, Buggy DJ. Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo. Br J Anaesth. 2003;90(5):665-70.
Nortcliffe, S. A., Shah, J., & Buggy, D. J. (2003). Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo. British Journal of Anaesthesia, 90(5), 665-70.
Nortcliffe SA, Shah J, Buggy DJ. Prevention of Postoperative Nausea and Vomiting After Spinal Morphine for Caesarean Section: Comparison of Cyclizine, Dexamethasone and Placebo. Br J Anaesth. 2003;90(5):665-70. PubMed PMID: 12697596.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo. AU - Nortcliffe,S-A, AU - Shah,J, AU - Buggy,D J, PY - 2003/4/17/pubmed PY - 2003/6/5/medline PY - 2003/4/17/entrez SP - 665 EP - 70 JF - British journal of anaesthesia JO - Br J Anaesth VL - 90 IS - 5 N2 - BACKGROUND: Low-dose intrathecal (spinal) morphine (0.1-0.2 mg) for Caesarean section delivers excellent postoperative analgesia but is associated with significant nausea and vomiting. We compared the antiemetic efficacy of cyclizine, dexamethasone, and placebo in this clinical setting. METHODS: Ninety-nine women undergoing elective Caesarean section under spinal anaesthesia were allocated randomly, in a double-blind study design, to receive either cyclizine 50 mg, dexamethasone 8 mg, or placebo as a single-dose infusion in saline 0.9%, 100 ml on completion of surgery. Spinal anaesthesia consisted of: hyperbaric bupivacaine 0.5%, 2.0 ml; fentanyl 10 micro g; and spinal morphine 0.2 mg. The primary outcome measure was the incidence of nausea. RESULTS: The incidence of nausea was significantly less in patients receiving cyclizine compared with dexamethasone and placebo (33 vs 60 and 67%, respectively, P<0.05). Severity of nausea and number of vomiting episodes were also less at 3-6 h in cyclizine patients. Overall satisfaction with postoperative care at 24 h, expressed on a 100 mm visual analogue scale, was greater in cyclizine [78 (28)] than either dexamethasone [58 (31), P=0.03] or placebo [51 (28), P=0.008]. CONCLUSION: We conclude that following spinal morphine 0.2 mg and fentanyl 10 micro g analgesia for Caesarean section, cyclizine 50 mg i.v. reduces the incidence of nausea compared with dexamethasone 8 mg i.v. or placebo. It also lessens the severity of nausea and vomiting, and increases maternal satisfaction in the early postoperative period. SN - 0007-0912 UR - https://www.unboundmedicine.com/medline/citation/12697596/Prevention_of_postoperative_nausea_and_vomiting_after_spinal_morphine_for_Caesarean_section:_comparison_of_cyclizine_dexamethasone_and_placebo_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0007-0912(17)37563-3 DB - PRIME DP - Unbound Medicine ER -