Effectiveness of Intravenous Metoclopramide Prophylaxis on the Reduction of Intraoperative and Early Postoperative Nausea and Vomiting after Emergency Caesarean Section under Spinal Anaesthesia

Abstract

Background: Nausea and vomiting is a common problem after spinal anaesthesia after cesarean section. Metoclopramide is reported to be effective in reducing the incidence and severity of nausea and vomiting (NV). However, its effectiveness as monotherapy remains unexplored. Aims: We aimed to assess the effectiveness of metoclopramide prophylaxis on the prevention of nausea and vomiting after emergency cesarean section under spinal anaesthesia. Methods and material: A prospective non-controlled study was conducted at a referral hospital. Patients classified as metoclopramide group who received 10 mg IV prophylaxis versus no prophylaxis group. Pre-tested checklist and patient interview were employed to collect the data during operation, at 2 h, 4 h and 6 h after cesarean section. Student’s t-test or Mann-Whitney U tests were used to compare the incidence and severity of nausea and vomiting between the groups. Chi-square and Fisher exact tests were used to compare the proportion of categorical variables between the groups. Results: The overall incidence of intraoperative and early postoperative nausea and vomiting were 25.8% and 48.5% in the treatment (n=66) group and non-treatment (n=66) group respectively. Prophylactic metoclopramide significantly reduced the overall incidence of intraoperative and early postoperative nausea and vomiting (25.8% vs. 48.5%, p=0.012) compared with non-treatment group. The median score for nausea on numeric rating scale was also reduced in the prophylaxis at the end of CS, 2 h and at 4 h after CS. Conclusion: The incidences of nausea and vomiting were high. The administration of prophylactic metoclopramide remarkably reduced the incidence and severity of intraoperative and early postoperative nausea and vomiting compared to the non-treatment group. We recommend metoclopramide prophylaxis for parturients undergoing emergency cesarean section under spinal anaesthesia. In addition, preoperative risk stratification strategies and perioperative nausea and vomiting management protocols need to be established in the hospital.