Intrathecal atropine to prevent postoperative nausea and vomiting after Cesarean section: a randomized, controlled trial.
Author(s): Baciarello M, Cornini A, Zasa M, Pedrona P, Scrofani G, Venuti FS, Fanelli G
Affiliation(s): Department of Anesthesiology, Critical Care and Pain Medicine, University Hospital of Parma, Parma, Italy. firstname.lastname@example.org
Publication date & source: 2011-08, Minerva Anestesiol., 77(8):781-8.
Publication type: Randomized Controlled Trial
BACKGROUND: Postoperative nausea and vomiting (PONV) is a common adverse effect of intrathecal morphine, especially after Cesarean section. This randomized controlled trial investigated the effects of intrathecal administration of a small-dose of atropine on postoperative nausea and vomiting after Cesarean section. METHODS: Parturients with ASA physical status class I-II scheduled for elective Cesarean section and consenting to spinal anesthesia were enrolled. They received 0.5% hyperbaric bupivacaine 12.5 mg, morphine 200 microg and one of the following three solutions: atropine 100 microg intrathecally and saline intravenously; saline intrathecally and atropine 100 microg intravenously; saline only both intravenously and intrathecally. We examined the incidence and severity of PONV, pain ratings and the need for analgesics. RESULTS: We followed 204 parturients. The incidence of PONV was 15%, 37% and 49% in the three groups, respectively (P<0.001). The relative risk reduction for PONV when using intrathecal atropine was 69% vs. placebo and 59% vs. intravenous atropine. No differences were noted in terms of postoperative pain. CONCLUSION: Intrathecal atropine had a significant antiemetic effect, making it a useful adjunct for intrathecal opioid-related PONV.