Antiemetic in Caesarean section under spinal anaesthesia: new option

Abstract

Objective: Postoperative nausea and vomiting (PONV) after spinal anaesthesia for caesarean delivery are distressing to patients, anaeathesist and surgeon. This study was designed to evaluate the efficacy and safety of granisetron and ramosetron (both potent 5HT3 receptor antagonist) on the incidences of nausea and vomiting in caesarean delivery after spinal anaesthesia in India. Place & Duration of Study: The study was done at Eden Hospital, Medical College, Kolkata 700073, India for six months (November, 2011 to April, 2012). Patients, Design & Methods of Study: In this randomized, double-blind study, 120 parturients (60 in each group) received granisetron (2mg in 2 ml) or ramosetron (0.3 mg in 2 ml) intravenously immediately after clamping of the foetal umbilical cord. Nausea, vomiting and adverse events were then observed for 48 h after administration of spinal anaesthesia. Results: A complete response (defined as no postoperative nausea and vomiting) during first 0-2 h postoperative after administration of spinal anaesthesia was achieved in 83.3 % of patients with granisetron and in 86% of patients with ramosetron. The corresponding incidence during 2 to 24 h was 85% and 88.3 %, while it was 70% and 91.6% at 24-48 h after anesthesia (p < 0.05). At 24-48 h after anesthesia, nausea and vomiting were less severe in patients who received ramosetron than in those who received granisetron (p < 0.05). Patients who received ramosetron were also more satisfied than those who received granisetron (p < 0.05). No difference in adverse events was observed in any of the groups. Conclusion: Prophylactic therapy with ramosetron is more effective than prophylactic therapy with granisetron for the long-term prevention of PONV in caesarean section in India.