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///2010 Abstract Details
2010 Abstract Details2019-08-03T15:49:10-05:00

Prophylactic dimenhydrinate does not reduce nausea and vomiting during Cesarean delivery under spinal anesthesia: a randomized, double-blind, placebo-controlled trial

Abstract Number: 53
Abstract Type: Original Research

Jose C.A. Carvalho MD, PhD1 ; Gopakumar S Nair MD2; Kristi Downey MSc3; Mrinalini Balki MD4

Introduction: Intra-operative nausea and vomiting (IONV) during Cesarean delivery (CD) remains a clinical problem (1). Dimenhydrinate has been used to treat nausea and vomiting during pregnancy, with no adverse fetal and neonatal effects (2). We assessed the efficacy of prophylactic dimenhydrinate for preventing IONV during CD.

Methods: This RCT was conducted with REB approval and informed consent. We enrolled term pregnant women undergoing elective CD under spinal anesthesia (SA). The study group received dimenhydrinate 25 mg, and the control group received saline, intravenously, before the administration of SA. Monitoring included ECG, NIBP, and SpO2. Spinal Anesthesia was achieved with 0.75% hyperbaric bupivacaine 15 mg mixed with fentanyl 10 g and morphine 100 g. Patients were co-loaded with 10 ml/kg of lactated Ringers solution, and SBP was tentatively maintained at baseline with intermittent boluses of 100 g of phenylephrine. If the patients heart rate was < 50 beats per minute, boluses of ephedrine 5 mg were used. Upon delivery, patients received 0.5 IU of oxytocin intravenously, followed by an infusion of 40 mU/min. Patients complaints of nausea and vomiting were recorded. Persistent nausea or vomiting was treated with dimenhydrinate 25 mg, and further with 1 mg of granisetron. Patients sedation was assessed by the Ramsay sedation scale. The Apgar score and other neonatal data were recorded. The patients were visited at 4 h and 24 h postoperatively, and the incidence of nausea and vomiting was noted. The primary outcome was the incidence of IONV.

Results: We approached 256 patients, recruited 164, and entered 150 in the database. The incidence of nausea was similar in the study and control groups, both pre-delivery (p=0.985) and post delivery (p=0.482). Only 3 patients (4.2%) in the control group vomited in the post-delivery period. The incidence of hypotension was also similar in the study and control groups, both pre-delivery (0.096) and post-delivery (p=0.158). Sedation scores and neonatal outcomes were similar in both groups.

Discussion: The prophylactic use of dimenhydrinate does not decrease the incidence of IONV during CD. These results are similar to those obtained at our institution with the prophylactic use of granisetron. Further reduction of IONV during CD may be obtained by the optimization of hemodynamic control.

References: 1. Anesth Analg 2007; 104: 679-683; 2. J Obstet Gynaecol Can 2002; 24: 817-831

SOAP 2010