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Can we predict who will develop postoperative nausea and vomiting following cesarean delivery under spinal anesthesia?
Abstract Number: T-06
Abstract Type: Original Research
Postoperative nausea and vomiting (PONV) occur commonly in women undergoing cesarean delivery. Numerous studies have investigated risk factors for PONV in the general surgical population, and a number of risk scores have been developed. No such studies have been conducted in obstetric patients and it is not known if those risk scores are applicable to parturients. We therefore performed this study to assess risk factors for PONV in women undergoing cesarean delivery under spinal anesthesia.
This is a post-hoc analysis of data from two multicenter randomized controlled trials that investigated PONV. Anesthetic management was similar in both studies and included spinal anesthesia with 12 mg hyperbaric bupivacaine, 15 mcg fentanyl and 150 mcg morphine. Intraoperatively systolic blood pressure (SBP) was maintained within 20 % of baseline using a prophylactic phenylephrine (PE) infusion or boluses of PE for the treatment of hypotension according to a predefined algorithm. Potential risk factors for PONV based on available literature with some added pregnancy specific factors were collected: history of PONV, motion sickness, morning sickness, or hyperemesis gravidarum, smoking during or prior to pregnancy, preoperative nausea, intraoperative nausea and vomiting (IONV), intraoperative SBP drop >20%, use of intraoperative rescue antiemetics, and exteriorization of the uterus. Additional covariables included receipt of prophylactic antiemetics and method of phenylephrine administration. We used random effects meta-analysis regression methods that include a random effect for study and fixed effects for PE infusion and prophylactic antiemetic treatment. Covariates with a significant association at p<0.1 were subsequently included in a final multivariate random effects model to estimate their independent association with PONV.
460 patients were included in the analysis. A chi-square test of heterogeneity for the rates of PONV found no significant difference (p=0.3) between the two studies. 381 patients received prophylactic PE infusions, 260 received no prophylactic antiemetics, 99 received metoclopramide and 101 received a combination of metoclopramide and ondansetron. PONV occurred in 250 (54%) patients. Results are summarized in the table.
Non-smoking was the only risk factor for PONV in our analysis. History of morning sickness was associated with increased risk for PONV, but was not statistically significant.