Background: Control of intraoperative nausea vomiting during caesarean section under spinal anaesthesia is a challenge for every obstetric anaesthesiologist mostly because of its multiple etiology. In this study, the effects of IV Ondansetron (4 mg), Dexamethasone (8mg) and sub hypnotic infusion dose of Propofol were compared for prevention of intraoperative nausea and vomiting during caesarean delivery under spinal anaesthesia.

Materials and Methods: A comparative, double-blinded study was carried out on 90parturient 2^nd Gravida parturientby allocating them into three groups using computer-generated method. Group O (n = 30) received intravenous (IV) Ondansetron 4 mg, Group D (n = 30) received (IV) Dexamethasone 8 mg and Group P (n= 30) received Propofol 10 mg IV bolus followed by an IV infusion of 1mg/kg/hr respectively after the delivery of baby and clamping the cord. Intraoperative emetic episodes were observed, and safety assessments were performed by an investigator, and propofol infusion was stopped at the end of surgery. Chi-square test and ANOVA were used for statistical analysis wherever appropriate and P < 0.05 was considered significant.

Results: The maternal demographics and operative management were comparable among the three groups. The incidence of nausea, retching, and vomiting in the intraoperative, post-delivery period were: Group O: Group D: Group P Nausea 58.6% versus 10.3% and 20.6%   P = 0.000; Retching 44.8% versus 13.8% and 24.1% P = 0.027, Vomiting 41.3%, 13.7%, versus 17.4% P = 0.028. No clinically significant adverse events were observed among the groups.

Discussion: The IV dexamethasone 8 mg and IV Propofol 10 mg bolus followed by infusion of propofol 1 mg/kg/h is better than IV Ondansetron 4 mg for reduction of the incidence of nausea, retching, and vomiting in the caesarean section under spinal anesthesia.

Keywords: Antiemetic, caesarean delivery, ondansetron, dexamethasone, propofol, spinal anesthesia

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Dr Neetika Mishra M.D

Associate Professor, Department of Anaesthesiology, North Bengal Medical College