Acta Scientific Gastrointestinal Disorders (ASGIS)(ISSN: 2582-1091)

Research Article Volume 4 Issue 11

Dexamethasone for Management of Nausea and Vomiting during and after Spinal Anaesthesia for Elective Caesarean Section

Tkachenko R1, Pyasetska NV2*, Petrychenko VV1, Shalko MN1

1Department of Obstetrics, Gynecology and Reproduction, Shupik National Healthcare University of Ukraine, Ukraine
2Department of Anaesthesiology and Intensive Care, Kyiv City Center of Reproductive and Perinatal Medicine, Ukraine

*Corresponding Author: Pyasetska NV, Department of Anaesthesiology and Intensive Care, Kyiv City Center of Reproductive and Perinatal Medicine, Ukraine.

Received: September 15, 2021; Published: October 27, 2021

×

Abstract

Spinal anesthesia is widely performed for elective caesarean section. But some early complications of spinal anesthesia, especially arterial hypotonia, shivering, nausea and vomiting, pruritus can nullify all the benefits of this anesthesia.

This randomized, prospective, clinical experimental, placebo-controlled study was undertaken to compare the efficiency of intrathecal introduction of dexamethasone or intravenous introduction combination of dexamethasone and ondansetron for prevention nausea and vomiting, arterial hypotonia, shivering during and after spinal anesthesia for elective caesarean section. All 124 healthy patients were randomized by age (18 - 38 years), weight and BMI (65 - 95 kg, BMI = 20 - 29), gestational period (36 - 40 weeks), ASA grade (I-II), indications for surgery (not urgent), total blood loss volume (500 - 800 ml), duration of surgery (20 - 40 min), and postoperative period in PACU (6 - 10 hours).

Base combination for intrathecal administration for each patient were hyperbaric bupivacaine 0.5% 11 mg, intrathecal 10 mcg fentanyl and intrathecal 100 mcg morphinе.

Group KONTR (n = 41) additionally received intrathecal 1ml of normal saline like placebo.

Group ITD (n = 42) additionally received 4mg (1ml) intrathecal dexamethasone, and Group IVDO (n = 41) received intravenous combination of 8mg dexamethasone and 4mg ondansetron directly after spinal punction.

All data of patient`s monitoring during operation, all the complications during and after spinal anesthesia for elective caesarean section were entered into the individual observation card of the patient. The occurrence of nausea, vomiting, arterial hypotension and shivering were a point of special interest in this study.

Software SPSS 22.0 and methods of variational statistics used to analyze data base.

Induced by spinal anesthesia for elective caesarean section arterial hypotensia and nausea in Group ITD (intrathecal dexamethasone) vs KONTR Group significantly decreased (Pearson's χ2 = 0.487 and χ2 = 0.479, p = 0.002 in both cases). Mean arterial pressure (MAP) was significantly higher at (p ≤ 0.014 and p ≤ 0.026) at 5 minutes and 10 minutes after spinal punction in Group ITD. Cases of nausea the most common in KONTR Group (intrathecal base combination bupivacaine with opioids and placebo). Nausea occurred with equal frequency (p = 0.539) in Group ITD (intrathecal dexamethasone) and IVDO (intravenous dexamethasone plus ondansetron combination), but intrathecal dexamethasone additionally prevented the occurrence of arterial hypotensia (p = 0.002). There was no significant difference between the groups in occurrence of vomiting (a small number of casas for reliable statistical analysis). Induced by spinal anesthesia for elective caesarean section shivering in Group ITD (intrathecal dexamethasone) vs Group KONTR was significantly lower frequency (Pearson's χ2 = 0.325, p < 0.05) in intra- and postoperative period.

 

Keywords: Dexamethasone; Ondansetron; Spinal Anesthesia; Adjuvant; Caesarean Section; Nausea; Vomiting; Arterial Hypotension

 

×

References

  1. Chooi Cheryl., et al. “Techniques for preventing hypotension during spinal anaesthesia for caesarean section”. The Cochrane Database of Systematic Reviews7 (2020): CD002251.
  2. Fitzgerald JP., et al. “Prevention of hypotension after spinal anaesthesia for caesarean section: a systematic review and network meta-analysis of randomised controlled trials”. Anaesthesia1 (2020): 109-121.
  3. Kinsella SM., et al. “International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia”. Anaesthesia1 (2018): 71-92.
  4. Ryu Choongun., et al. “Vasopressors for the management of maternal hypotension during cesarean section under spinal anesthesia: A Systematic review and network meta-analysis protocol”. Medicine 1 (2019): e13947.
  5. Swain Amlan., et al. “Adjuvants to local anesthetics: Current understanding and future trends”. World Journal of Clinical Cases 8 (2017): 307-323.
  6. Pehora Carolyne., et al. “Dexamethasone as an adjuvant to peripheral nerve block”. The Cochrane Database of Systematic Reviews 11 (2017): CD011770.
  7. Moore Sean G. “Intravenous Dexamethasone as an Analgesic: A Literature Review”. AANA Journal6 (2018): 488-493.
  8. Dahl JB., et al. “Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: a qualitative and quantitative systematic review of randomized controlled trials”. Anesthesiology6 (1999): 1919-1927.
  9. Kirksey Meghan A., et al. “Local Anesthetic Peripheral Nerve Block Adjuvants for Prolongation of Analgesia: A Systematic Qualitative Review”. PloS one9 (2015): e0137312.
  10. Maged Ahmed M., et al. “Comparison of local and intra venous dexamethasone on post operative pain and recovery after caeseream section. A randomized controlled trial”. Taiwanese Journal of Obstetrics and Gynecology3 (2018): 346-350.
  11. Haque MM., et al. “Efficacy of 0.5% Hyperbaric Bupivacaine with Dexamethasone versus 0.5% Hyperbaric Bupivacaine alone in Spinal Anaesthesia for Patient Undergoing Lower Abdominal Urological and Lower Limb Orthopedic Surgeries”. Mymensingh Medical Journal: MMJ2 (2018): 375-381.
  12. Imeh Akpan., et al. “Dexamethasone versus a combination of dexamethasone and ondansetron as prophylactic antiemetic in patients receiving intrathecal morphine for caesarean section”. African Health Sciences2 (2014): 453-459.
  13. Eberhart LHJ., et al. “Impact of a multimodal anti-emetic prophylaxis on patient satisfaction in high-risk patients for postoperative nausea and vomiting”. Anaesthesia10 (2002): 1022-1027.
  14. Myles PS., et al. “Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients”. British Journal of Anaesthesia1 (2000): 6-10.
  15. Hill RP., et al. “Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo”. Anesthesiology4 (2000): 958-967.
  16. Gan Tong J., et al. “Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting”. Anesthesia and Analgesia 2 (2020): 411-448.
  17. Caughey Aaron B., et al. “Guidelines for intraoperative care in cesarean delivery: Enhanced Recovery After Surgery Society Recommendations (Part 2)”. American Journal of Obstetrics and Gynecology 6 (2018): 533-544.
  18. Tan Hon Sen and Ashraf S Habib. “The optimum management of nausea and vomiting during and after cesarean delivery”. Best Practice and Research Clinical Anaesthesiology 4 (2020): 735-747.
  19. Holte Kathrine and Henrik Kehlet. “Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications”. Journal of the American College of Surgeons 5 (2002): 694-712.
  20. Schug Stephan A., et al. “Acute pain management: scientific evidence, fourth edition, 2015”. The Medical journal of Australia8 (2016): 315-357.
×

Citation

Citation: Pyasetska NV., et al. “Dexamethasone for Management of Nausea and Vomiting during and after Spinal Anaesthesia for Elective Caesarean Section. Acta Scientific Gastrointestinal Disorders 4.11 (2021): 54-57.




Metrics

Acceptance rate35%
Acceptance to publication20-30 days
Impact Factor0.835

Indexed In




News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is December 15, 2021.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of “Best Article of the Issue”.
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.
  • Contact US