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

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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.

Copyright

Copyright: © 2021 Pyasetska NV., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.