Comparative antiemetic efficacy of intrathecal fentanyl and intravenous metoclopromide, during caesarean section under spinal anaesthesia

ABSTRACT

The aim of this study is to compare the efficacy of intrathecal fentanyl and intravenous metoclopromide for reducing emetic symptoms in parturient undergoing caesarean section under spinal anaesthesia. In a randomized double-blind placebo-controlled study, including 150 American Society of Anesthesiologists [ASA] physical status I,II parturient submitted to bupivacaine spinal anaesthesia for elective caesarean section received either intrathecal fentanyl 20 micrograms [n=49], intravenous metoclopromide 10 mg [n=48] or intravenous saline [n=50]. Drugs were administered depending on their treatment group. Emetic episodes were recorded during and after spinal anaesthesia for caesarean delivery. If intraoperative nausea and vomiting had not subsided completely 5 minutes after giving the study drugs, we treated them with Droperidol. The study was conducted at Queen Alias and Prince Ali Ibn Al Hussein Hospitals between January 2002 and December 2003. Nausea and vomiting occurred in 11.6% of total cases. They were absent in 91.8% of the fentanyl group; 91.6% of the metoclopromide group and 60% of the placebo group [p<0.001 for both the fentanyl and metoclopromide groups versus the placebo group]. Emetic symptoms were more frequent after clamping of the umbilical cord [25.9%] than prior to it [16.3%] p <0.005]. Both intrathecal fentanyl and intravenous metoclopromide were similarly effective; and significantly better than placebo in reducing the incidence and severity of intraoperative emetic symptoms in caesarean section patients under spinal anaesthesia