Metoclopramide for nausea and vomiting prophylaxis during and after Caesarean delivery: a systematic review and meta-analysis
2012; Elsevier BV; Volume: 108; Issue: 3 Linguagem: Inglês
10.1093/bja/aer509
ISSN1471-6771
AutoresBasem M. Mishriky, Ashraf S. Habib,
Tópico(s)Cardiac, Anesthesia and Surgical Outcomes
ResumoNausea and vomiting occur commonly during and after Caesarean delivery (CD) performed under neuraxial anaesthesia. Metoclopramide is a prokinetic agent reported to be safe in parturients. This meta-analysis assesses the efficacy of metoclopramide for prophylaxis against intra- and postoperative nausea and vomiting (IONV and PONV) in parturients undergoing CD under neuraxial anaesthesia. We performed a literature search of MEDLINE (1966–2011), Cochrane Central Register of Controlled Trials, EMBASE (1947–2011), Google scholar, and CINAHL for randomized controlled trials which compared metoclopramide with placebo in women having CD under neuraxial anaesthesia. Eleven studies with 702 patients were included in the analysis. Administration of metoclopramide (10 mg) resulted in a significant reduction in the incidence of ION and IOV when given before block placement [relative risk (RR) (95% confidence interval, 95% CI)=0.27 (0.16, 0.45) and 0.14 (0.03, 0.56), respectively] or after delivery [RR (95% CI)=0.38 (0.20, 0.75) and 0.34 (0.18, 0.66), respectively]. The incidence of early (0–3 or 0–4 h) PON and POV [RR (95% CI)=0.47 (0.26, 0.87) and 0.45 (0.21, 0.93), respectively] and overall (0–24 or 3–24 h) PON (RR 0.69; 95% CI 0.52, 0.92) were also reduced with metoclopramide. Extra-pyramidal side-effects were not reported in any patient. In conclusion, this review suggests that metoclopramide is effective and safe for IONV and PONV prophylaxis in this patient population. Given the quality of the studies and the infrequent use of neuraxial opioids, these results should be interpreted with caution in current practice and further studies are needed to confirm those findings. Nausea and vomiting occur commonly during and after Caesarean delivery (CD) performed under neuraxial anaesthesia. Metoclopramide is a prokinetic agent reported to be safe in parturients. This meta-analysis assesses the efficacy of metoclopramide for prophylaxis against intra- and postoperative nausea and vomiting (IONV and PONV) in parturients undergoing CD under neuraxial anaesthesia. We performed a literature search of MEDLINE (1966–2011), Cochrane Central Register of Controlled Trials, EMBASE (1947–2011), Google scholar, and CINAHL for randomized controlled trials which compared metoclopramide with placebo in women having CD under neuraxial anaesthesia. Eleven studies with 702 patients were included in the analysis. Administration of metoclopramide (10 mg) resulted in a significant reduction in the incidence of ION and IOV when given before block placement [relative risk (RR) (95% confidence interval, 95% CI)=0.27 (0.16, 0.45) and 0.14 (0.03, 0.56), respectively] or after delivery [RR (95% CI)=0.38 (0.20, 0.75) and 0.34 (0.18, 0.66), respectively]. The incidence of early (0–3 or 0–4 h) PON and POV [RR (95% CI)=0.47 (0.26, 0.87) and 0.45 (0.21, 0.93), respectively] and overall (0–24 or 3–24 h) PON (RR 0.69; 95% CI 0.52, 0.92) were also reduced with metoclopramide. Extra-pyramidal side-effects were not reported in any patient. In conclusion, this review suggests that metoclopramide is effective and safe for IONV and PONV prophylaxis in this patient population. Given the quality of the studies and the infrequent use of neuraxial opioids, these results should be interpreted with caution in current practice and further studies are needed to confirm those findings. Editor's key points•The use of metoclopramide has declined in many surgical settings.•The use of metoclopramide 10 mg for prophylaxis against intra- and postoperative nausea and vomiting associated with Caesarean section is analysed.•Metoclopramide was effective in this group of patients.•The role of this inexpensive drug may be worthy of re-evaluation. •The use of metoclopramide has declined in many surgical settings.•The use of metoclopramide 10 mg for prophylaxis against intra- and postoperative nausea and vomiting associated with Caesarean section is analysed.•Metoclopramide was effective in this group of patients.•The role of this inexpensive drug may be worthy of re-evaluation. Intra- and postoperative nausea and vomiting (IONV and PONV) are common and can be distressing to patients undergoing Caesarean delivery (CD) under neuraxial anaesthesia. The incidence of IONV varied among different studies with rates up to 60–80% being reported.1Balki M Carvalho JC Intraoperative nausea and vomiting during cesarean section under regional anesthesia.Int J Obstet Anesth. 2005; 14: 230-241doi:10.1016/j.ijoa.2004.12.004Abstract Full Text Full Text PDF PubMed Scopus (120) Google Scholar The aetiology of IONV is multifactorial, and include progesterone-induced reduction in the lower oesophageal sphincter tone, increased intra-gastric pressure,2Lussos SA Bader AM Thornhill ML Datta S The antiemetic efficacy and safety of prophylactic metoclopramide for elective cesarean delivery during spinal anesthesia.Reg Anesth. 1992; 17: 126-130PubMed Google Scholar hypotension, exteriorization of the uterus, visceral stimulation, and the use of neuraxial opioids.1Balki M Carvalho JC Intraoperative nausea and vomiting during cesarean section under regional anesthesia.Int J Obstet Anesth. 2005; 14: 230-241doi:10.1016/j.ijoa.2004.12.004Abstract Full Text Full Text PDF PubMed Scopus (120) Google Scholar Metoclopramide has multiple sites of action. It is a prokinetic drug that acts by increasing the tone of the lower oesophageal sphincter. It also has an anti-dopaminergic action on the chemoreceptor trigger zone and at higher doses has an anti-serotonergic activity.3Elliott P Seemungal BM Wallis DI Antagonism of the effects of 5-hydroxytryptamine on the rabbit isolated vagus nerve by BRL 43694 and metoclopramide.Naunyn Schmiedebergs Arch Pharmacol. 1990; 341: 503-509PubMed Google Scholar 4Ireland SJ Straughan DW Tyers MB Influence of 5-hydroxytryptamine uptake on the apparent 5-hydroxytryptamine antagonist potency of metoclopramide in the rat isolated superior cervical ganglion.Br J Pharmacol. 1987; 90: 151-160Crossref PubMed Scopus (24) Google Scholar At a dose of 10 mg, it does not have a reliable anti-emetic effect when used for the prophylaxis of PONV in patients undergoing non-obstetric surgery under general anaesthesia.5Habib AS Gan TJ Evidence-based management of postoperative nausea and vomiting: a review.Can J Anaesth. 2004; 51: 326-341doi:10.1007/BF03018236Crossref PubMed Scopus (176) Google Scholar This dose was reported to be safe in the parturient,2Lussos SA Bader AM Thornhill ML Datta S The antiemetic efficacy and safety of prophylactic metoclopramide for elective cesarean delivery during spinal anesthesia.Reg Anesth. 1992; 17: 126-130PubMed Google Scholar 6Cohen SE Jasson J Talafre ML Chauvelot-Moachon L Barrier G Does metoclopramide decrease the volume of gastric contents in patients undergoing cesarean section?.Anesthesiology. 1984; 61: 604-607doi:10.1097/00000542-198411000-00025Crossref PubMed Scopus (41) Google Scholar and although it crosses the placental barrier, it is not associated with adverse neonatal effects.1Balki M Carvalho JC Intraoperative nausea and vomiting during cesarean section under regional anesthesia.Int J Obstet Anesth. 2005; 14: 230-241doi:10.1016/j.ijoa.2004.12.004Abstract Full Text Full Text PDF PubMed Scopus (120) Google Scholar Metoclopramide is a generic inexpensive drug. It is currently rarely used in the UK for the management of nausea and vomiting associated with neuraxial anaesthesia, possibly due to a perceived lack of efficacy. On the other hand, some centres in North America use it regularly for this purpose. We, therefore, performed this systematic review and meta-analysis to assess the efficacy of metoclopramide for the prophylaxis against IONV and PONV in parturients undergoing CD under neuraxial anaesthesia. We followed the recommendations of the PRISMA statement.7Liberati A Altman DG Tetzlaff J et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration.PLoS Med. 2009; 6: e1000100doi:10.1371/journal.pmed.1000100Crossref PubMed Scopus (10131) Google Scholar We searched MEDLINE (1966–2011), the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (1947–2011), Google scholar, and CINAHL for randomized controlled trials (RCTs) which compared metoclopramide with placebo in women having CD under neuraxial anaesthesia. The following terms and combination of terms were used for the search: 'metoclopramide', 'caesarean section', 'spinal anaesthesia', and 'epidural anaesthesia'. The search was done without language restrictions. The last computer search was done in June 2011. In addition, the bibliographies of retrieved articles were searched for additional studies. We searched for RCTs that compared metoclopramide with placebo in women undergoing CD under neuraxial anaesthesia and reported on the incidence of ION, IOV, PON, and/or POV. A study was excluded if the anaesthetic technique was not standardized or if metoclopramide was combined with another anti-emetic. Reviews, abstracts, letters to the editor, and retrospective studies were excluded. The articles that met the selection criteria were assessed separately by two authors using the seven-point modified Oxford scale.8Elia N Tramer MR Ketamine and postoperative pain—a quantitative systematic review of randomised trials.Pain. 2005; 113: 61-70doi:10.1016/j.pain.2004.09.036Abstract Full Text Full Text PDF PubMed Scopus (443) Google Scholar 9Jadad AR Moore RA Carroll D et al.Assessing the quality of reports of randomized clinical trials: is blinding necessary?.Control Clin Trials. 1996; 17: 1-12doi:10.1016/0197-2456(95)00134-4Abstract Full Text PDF PubMed Scopus (13578) Google Scholar Any discrepancies were resolved by discussion. The two reviewers extracted data independently. A data collection sheet was created and included data on: (i) anaesthetic technique, (ii) neuraxial opioid use, (iii) number of patients included, (iv) time of administration and dose of metoclopramide, (v) method of nausea and vomiting assessment, (vi) threshold for treating hypotension, (vii) vasopressor used to treat hypotension, (viii) level of block, (ix) need for additional analgesia, (x) incidence of intraoperative hypotension, (xi) exteriorization of the uterus, (xii) ION/IOV, (xiii) PON/POV, (xiv) need for rescue anti-emetics, and (xv) side-effects. The primary outcomes for this meta-analysis were ION and IOV. Secondary outcomes were PON, POV, need for rescue anti-emetics, and side-effects. The method of nausea and vomiting assessment was considered adequate, if the patients were directly questioned about emetic symptoms and either a clear definition for nausea and vomiting or a scale for nausea severity was included in the Methods section. For ION and IOV, separate analyses were performed according to whether metoclopramide was administered before block placement or after cord clamping. For the latter analysis, data include events occurring after delivery, whereas results cover the entire intraoperative period when metoclopramide was given before block placement. For PON and POV, data were pooled as early PON/POV (0–3 or 0–4 h) and overall PON/POV (0–24 or 3–24 h). Visual analogue scale (VAS) scores for sedation reported as 0–100 scale were converted to a 0–10-point scale for analysis. If the studies had more than two groups, only data from the metoclopramide and placebo groups were extracted. Dichotomous data were summarized using relative risk (RR) with 95% confidence interval (CI). If the 95% CI included a value of 1, we considered that the difference between metoclopramide and placebo was not statistically significant. Continuous data were summarized as mean difference (MD) with 95% CI. If the 95% CI included a value of 0, we considered that the difference between metoclopramide and control was not statistically significant. Analyses were performed using the Review Manager (RevMan; Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011). A random effects model was used. For statistically significant differences in outcome, the number needed to treat (NNT) was calculated to estimate the overall clinical impact of the intervention. If the statistical test for heterogeneity was significant (P 50%, the reason for heterogeneity was explored. Forest plots were used to graphically represent and evaluate treatment effects. Sensitivity analyses were performed for the primary endpoints of ION/IOV according to the use of spinal anaesthesia and receipt of spinal opioids. Another sensitivity analysis was performed according to the quality of the included studies by restricting the analysis to studies with a modified Oxford score of 4 or higher. Forty-six studies were identified and assessed for inclusion in this review (Fig. 1). Of those, 35 were excluded. A total of 11 studies with 702 patients (349 received metoclopramide and 353 received placebo) were included in the final analysis2Lussos SA Bader AM Thornhill ML Datta S The antiemetic efficacy and safety of prophylactic metoclopramide for elective cesarean delivery during spinal anesthesia.Reg Anesth. 1992; 17: 126-130PubMed Google Scholar 10Biswas BN Rudra A Das SK Nath S Biswas SC A comparative study of glycopyrrolate, dexamethasone and metoclopramide in control of post-operative nausea and vomiting after spinal anaesthesia for caesarean delivery.Indian J Anaesth. 2003; 47: 198-200Google Scholar, 11Chestnut DH Vandewalker GE Owen CL Bates JN Choi WW Administration of metoclopramide for prevention of nausea and vomiting during epidural anesthesia for elective cesarean section.Anesthesiology. 1987; 66: 563-566doi:10.1097/00000542-198704000-00022Crossref PubMed Scopus (41) Google Scholar, 12Danzer BI Birnbach DJ Stein DJ Kuroda MM Thys DM Does metoclopramide supplement postoperative analgesia using patient-controlled analgesia with morphine in patients undergoing elective cesarean delivery?.Reg Anesth. 1997; 22: 424-427doi:10.1016/S1098-7339(97)80027-2Crossref PubMed Google Scholar, 13Duman A Apiliogullari S Gok F Sutcu E Soysal S Toy H A randomized comparison of dimenhydrinate, metoclopramide and placebo for the prevention of nausea and vomiting following intrathecal fentanyl and morphine in cesarean delivery.Nobel Med. 2010; 6: 13-19Google Scholar, 14Fujii Y Tanaka H Toyooka H Prevention of nausea and vomiting with granisetron, droperidol and metoclopramide during and after spinal anaesthesia for caesarean section: a randomized, double-blind, placebo-controlled trial.Acta Anaesthesiol Scand. 1998; 42: 921-925doi:10.1111/j.1399-6576.1998.tb05350.xCrossref PubMed Scopus (31) Google Scholar, 15Garcia-Miguel FJ Montano E Mart Vicente V Fuentes AL Alsina FJ San Jose JA Prophylaxis against intraoperative nausea and vomiting during spinal anesthesia for cesarean section: a comparative study of ondansetron versus metoclopramide.Internet J Anesthesiol. 2000; 4 (published April 1, 2000; last updated April 1, 2000 (accessed 23 September 2011))Available from http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ija/vol4n2/nvpo.xmlGoogle Scholar, 16Maranhao MVM Coelho VV Ivo CMA Maranhao MHC Amaral EB A comparative study between metoclopramide and droperidol in the control of nausea and vomit in patients subjected to spinal blockade during cesarean section.Rev Bras Anestesiol. 1988; 38: 245-249Google Scholar, 17Numazaki M Fujii Y Reduction of emetic symptoms during cesarean delivery with antiemetics: propofol at subhypnotic dose versus traditional antiemetics.J Clin Anesth. 2003; 15: 423-427doi:10.1016/S0952-8180(03)00086-2Abstract Full Text PDF PubMed Scopus (20) Google Scholar, 18Pan PH Moore CH Comparing the efficacy of prophylactic metoclopramide, ondansetron, and placebo in cesarean section patients given epidural anesthesia.J Clin Anesth. 2001; 13: 430-435doi:10.1016/S0952-8180(01)00294-XAbstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 19Stein DJ Birnbach DJ Danzer BI Kuroda MM Grunebaum A Thys DM Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section.Anesth Analg. 1997; 84: 342-345Crossref PubMed Google Scholar (Table 1). The minimum modified Oxford score of an included study was 1 and the maximum score was 6 with a median score of 4.Table 1Characteristics of the included studies. MOS, modified Oxford scale; (R/C/B/F), randomization/concealment of allocation/double-blinding/flow of patients; n, number of patients per group; ION-IOV/PON-POV, intra-/postoperative nausea and vomiting; M, metoclopramide; C, control; SAP, systolic arterial pressure; VAS, visual/verbal analogue scaleReferenceMOS (R/C/B/F)nTime of administrationSpinal or epiduralThreshold to treat hypotensionVasopressorNeuraxial opioidsHypotension (%)Uterus; exteriorization (%)Data reportedPrimary outcome assessmentDefinition of nausea and vomiting and/or nausea scoreChestnut and colleagues11Chestnut DH Vandewalker GE Owen CL Bates JN Choi WW Administration of metoclopramide for prevention of nausea and vomiting during epidural anesthesia for elective cesarean section.Anesthesiology. 1987; 66: 563-566doi:10.1097/00000542-198704000-00022Crossref PubMed Scopus (41) Google Scholar3 (2/0/1/0)M: 34; C: 33After deliveryEpiduralSAP decrease >20% from baseline or below 100 mm HgI.V. ephedrineM: 29; C: 18M: 94; C: 79ION–IOV/PON–POVObservation intraoperatively and direct questioning about worst intraoperative nausea score after transfer to recoveryNausea score described VAS 0–100Maranhao and colleagues16Maranhao MVM Coelho VV Ivo CMA Maranhao MHC Amaral EB A comparative study between metoclopramide and droperidol in the control of nausea and vomit in patients subjected to spinal blockade during cesarean section.Rev Bras Anestesiol. 1988; 38: 245-249Google Scholar1 (1/0/0/0)M: 20; C: 20After deliverySpinalAP decrease >20% from baselineM: 30; C: 30ION–IOVNot reportedNot reportedLussos and colleagues2Lussos SA Bader AM Thornhill ML Datta S The antiemetic efficacy and safety of prophylactic metoclopramide for elective cesarean delivery during spinal anesthesia.Reg Anesth. 1992; 17: 126-130PubMed Google Scholar2 (1/0/1/0)M: 21; C: 21Before block placementSpinalSAP 20% below baseline or below 100 mm Hg5–10 mg i.v. ephedrine10 µg fentanylM: 19; C: 5M: 100; C: 100ION–IOVReporting by patients either spontaneously or after asked regularly about general well-beingNot reportedStein and colleagues19Stein DJ Birnbach DJ Danzer BI Kuroda MM Grunebaum A Thys DM Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section.Anesth Analg. 1997; 84: 342-345Crossref PubMed Google Scholar4 (1/1/2/0)M: 25; C: 25Before block placementSpinalSAP decrease >20% from baseline or below 100 mm Hg5–10 mg i.v. ephedrine10 µg fentanylM: 68; C: 76M: 100; C: 100ION–IOVDirect questioningNausea score described VAS 0–10Danzer and colleagues12Danzer BI Birnbach DJ Stein DJ Kuroda MM Thys DM Does metoclopramide supplement postoperative analgesia using patient-controlled analgesia with morphine in patients undergoing elective cesarean delivery?.Reg Anesth. 1997; 22: 424-427doi:10.1016/S1098-7339(97)80027-2Crossref PubMed Google Scholar5 (1/1/2/1)M: 17; C: 15Before block placementSpinalI.V. ephedrineION–IOV/PON–POVNot reportedNot reportedFujii and colleagues14Fujii Y Tanaka H Toyooka H Prevention of nausea and vomiting with granisetron, droperidol and metoclopramide during and after spinal anaesthesia for caesarean section: a randomized, double-blind, placebo-controlled trial.Acta Anaesthesiol Scand. 1998; 42: 921-925doi:10.1111/j.1399-6576.1998.tb05350.xCrossref PubMed Scopus (31) Google Scholar4 (2/0/2/0)M: 30; C: 30After deliverySpinalSAP decrease >20% from baseline or below 80 mm Hg5–10 mg i.v. ephedrineM: 93; C: 93ION–IOV/PON–POVDirect questioningNausea and vomiting definedGarcia-Miguel and colleagues15Garcia-Miguel FJ Montano E Mart Vicente V Fuentes AL Alsina FJ San Jose JA Prophylaxis against intraoperative nausea and vomiting during spinal anesthesia for cesarean section: a comparative study of ondansetron versus metoclopramide.Internet J Anesthesiol. 2000; 4 (published April 1, 2000; last updated April 1, 2000 (accessed 23 September 2011))Available from http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ija/vol4n2/nvpo.xmlGoogle Scholar4 (2/0/1/1)M: 48; C: 50After deliverySpinalSAP decrease >20% from baseline or below 90 mm Hg10 mg i.v. ephedrine10 µg fentanylM: 31; C: 26ION–IOVNot reportedNot reportedPan and Moore18Pan PH Moore CH Comparing the efficacy of prophylactic metoclopramide, ondansetron, and placebo in cesarean section patients given epidural anesthesia.J Clin Anesth. 2001; 13: 430-435doi:10.1016/S0952-8180(01)00294-XAbstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar4 (2/0/1/1)M: 51; C: 51After deliveryEpiduralSAP decrease >20% from baseline or below 90 mm Hg10 mg i.v. ephedrine100 µg fentanylM: 84; C: 86ION–IOV/PON–POVDirect questioningNausea score described VAS 0–10Numazaki and Fujii17Numazaki M Fujii Y Reduction of emetic symptoms during cesarean delivery with antiemetics: propofol at subhypnotic dose versus traditional antiemetics.J Clin Anesth. 2003; 15: 423-427doi:10.1016/S0952-8180(03)00086-2Abstract Full Text PDF PubMed Scopus (20) Google Scholar4 (2/0/2/0)M: 25; C: 25After deliverySpinalSAP decrease >20% from baseline or below 100 mm Hg5–10 mg i.v. ephedrineM: 40; C: 40M: 92; C: 92ION–IOVDirect questioningNausea and vomiting defined, and nausea score described (linear numerical scale 0-10)Biswas and colleagues10Biswas BN Rudra A Das SK Nath S Biswas SC A comparative study of glycopyrrolate, dexamethasone and metoclopramide in control of post-operative nausea and vomiting after spinal anaesthesia for caesarean delivery.Indian J Anaesth. 2003; 47: 198-200Google Scholar2 (1/0/1/0)M: 20; C: 20Before block placementSpinalSAP decrease >20% from baseline or below 90 mm Hg3 mg i.v. ephedrineM: 45; C: 40PON–POVNot reportedNot reportedDuman and colleagues13Duman A Apiliogullari S Gok F Sutcu E Soysal S Toy H A randomized comparison of dimenhydrinate, metoclopramide and placebo for the prevention of nausea and vomiting following intrathecal fentanyl and morphine in cesarean delivery.Nobel Med. 2010; 6: 13-19Google Scholar6 (2/0/2/2)M: 58; C: 63After deliverySpinalSAP below 90 mm Hg5 mg i.v. ephedrine20 µg fentanyl and 200 µg morphineM:30; C: 45PON–POVDirect questioningNausea and vomiting defined, and nausea score described (four-point scale) Open table in a new tab Spinal anaesthesia was used in nine studies,2Lussos SA Bader AM Thornhill ML Datta S The antiemetic efficacy and safety of prophylactic metoclopramide for elective cesarean delivery during spinal anesthesia.Reg Anesth. 1992; 17: 126-130PubMed Google Scholar 10Biswas BN Rudra A Das SK Nath S Biswas SC A comparative study of glycopyrrolate, dexamethasone and metoclopramide in control of post-operative nausea and vomiting after spinal anaesthesia for caesarean delivery.Indian J Anaesth. 2003; 47: 198-200Google Scholar 12Danzer BI Birnbach DJ Stein DJ Kuroda MM Thys DM Does metoclopramide supplement postoperative analgesia using patient-controlled analgesia with morphine in patients undergoing elective cesarean delivery?.Reg Anesth. 1997; 22: 424-427doi:10.1016/S1098-7339(97)80027-2Crossref PubMed Google Scholar, 13Duman A Apiliogullari S Gok F Sutcu E Soysal S Toy H A randomized comparison of dimenhydrinate, metoclopramide and placebo for the prevention of nausea and vomiting following intrathecal fentanyl and morphine in cesarean delivery.Nobel Med. 2010; 6: 13-19Google Scholar, 14Fujii Y Tanaka H Toyooka H Prevention of nausea and vomiting with granisetron, droperidol and metoclopramide during and after spinal anaesthesia for caesarean section: a randomized, double-blind, placebo-controlled trial.Acta Anaesthesiol Scand. 1998; 42: 921-925doi:10.1111/j.1399-6576.1998.tb05350.xCrossref PubMed Scopus (31) Google Scholar, 15Garcia-Miguel FJ Montano E Mart Vicente V Fuentes AL Alsina FJ San Jose JA Prophylaxis against intraoperative nausea and vomiting during spinal anesthesia for cesarean section: a comparative study of ondansetron versus metoclopramide.Internet J Anesthesiol. 2000; 4 (published April 1, 2000; last updated April 1, 2000 (accessed 23 September 2011))Available from http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ija/vol4n2/nvpo.xmlGoogle Scholar, 16Maranhao MVM Coelho VV Ivo CMA Maranhao MHC Amaral EB A comparative study between metoclopramide and droperidol in the control of nausea and vomit in patients subjected to spinal blockade during cesarean section.Rev Bras Anestesiol. 1988; 38: 245-249Google Scholar, 17Numazaki M Fujii Y Reduction of emetic symptoms during cesarean delivery with antiemetics: propofol at subhypnotic dose versus traditional antiemetics.J Clin Anesth. 2003; 15: 423-427doi:10.1016/S0952-8180(03)00086-2Abstract Full Text PDF PubMed Scopus (20) Google Scholar 19Stein DJ Birnbach DJ Danzer BI Kuroda MM Grunebaum A Thys DM Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section.Anesth Analg. 1997; 84: 342-345Crossref PubMed Google Scholar while epidural anaesthesia was used in two studies.11Chestnut DH Vandewalker GE Owen CL Bates JN Choi WW Administration of metoclopramide for prevention of nausea and vomiting during epidural anesthesia for elective cesarean section.Anesthesiology. 1987; 66: 563-566doi:10.1097/00000542-198704000-00022Crossref PubMed Scopus (41) Google Scholar 18Pan PH Moore CH Comparing the efficacy of prophylactic metoclopramide, ondansetron, and placebo in cesarean section patients given epidural anesthesia.J Clin Anesth. 2001; 13: 430-435doi:10.1016/S0952-8180(01)00294-XAbstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar Metoclopramide was given at a dose of 10 mg in 10 studies,2Lussos SA Bader AM Thornhill ML Datta S The antiemetic efficacy and safety of prophylactic metoclopramide for elective cesarean delivery during spinal anesthesia.Reg Anesth. 1992; 17: 126-130PubMed Google Scholar 10Biswas BN Rudra A Das SK Nath S Biswas SC A comparative study of glycopyrrolate, dexamethasone and metoclopramide in control of post-operative nausea and vomiting after spinal anaesthesia for caesarean delivery.Indian J Anaesth. 2003; 47: 198-200Google Scholar 12Danzer BI Birnbach DJ Stein DJ Kuroda MM Thys DM Does metoclopramide supplement postoperative analgesia using patient-controlled analgesia with morphine in patients undergoing elective cesarean delivery?.Reg Anesth. 1997; 22: 424-427doi:10.1016/S1098-7339(97)80027-2Crossref PubMed Google Scholar, 13Duman A Apiliogullari S Gok F Sutcu E Soysal S Toy H A randomized comparison of dimenhydrinate, metoclopramide and placebo for the prevention of nausea and vomiting following intrathecal fentanyl and morphine in cesarean delivery.Nobel Med. 2010; 6: 13-19Google Scholar, 14Fujii Y Tanaka H Toyooka H Prevention of nausea and vomiting with granisetron, droperidol and metoclopramide during and after spinal anaesthesia for caesarean section: a randomized, double-blind, placebo-controlled trial.Acta Anaesthesiol Scand. 1998; 42: 921-925doi:10.1111/j.1399-6576.1998.tb05350.xCrossref PubMed Scopus (31) Google Scholar, 15Garcia-Miguel FJ Montano E Mart Vicente V Fuentes AL Alsina FJ San Jose JA Prophylaxis against intraoperative nausea and vomiting during spinal anesthesia for cesarean section: a comparative study of ondansetron versus metoclopramide.Internet J Anesthesiol. 2000; 4 (published April 1, 2000; last updated April 1, 2000 (accessed 23 September 2011))Available from http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ija/vol4n2/nvpo.xmlGoogle Scholar, 16Maranhao MVM Coelho VV Ivo CMA Maranhao MHC Amaral EB A comparative study between metoclopramide and droperidol in the control of nausea and vomit in patients subjected to spinal blockade during cesarean section.Rev Bras Anestesiol. 1988; 38: 245-249Google Scholar, 17Numazaki M Fujii Y Reduction of emetic symptoms during cesarean delivery with antiemetics: propofol at subhypnotic dose versus traditional antiemetics.J Clin Anesth. 2003; 15: 423-427doi:10.1016/S0952-8180(03)00086-2Abstract Full Text PDF PubMed Scopus (20) Google Scholar, 18Pan PH Moore CH Comparing the efficacy of prophylactic metoclopramide, ondansetron, and placebo in cesarean section patients given epidural anesthesia.J Clin Anesth. 2001; 13: 430-435doi:10.1016/S0952-8180(01)00294-XAbstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 19Stein DJ Birnbach DJ Danzer BI Kuroda MM Grunebaum A Thys DM Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section.Anesth Analg. 1997; 84: 342-345Crossref PubMed Google Scholar while one study11Chestnut DH Vandewalker GE Owen CL Bates JN Choi WW Administration of metoclopramide for prevention of nausea and vomiting during epidural anesthesia for elective cesarean section.Anesthesiology. 1987; 66: 563-566doi:10.1097/00000542-198704000-00022Crossref PubMed Scopus (41) Google Scholar used a dose of 0.15 mg kg−1. Metoclopramide was given before block placement in four studies2Lussos SA Bader AM Thornhill ML Datta S The antiemetic efficacy and safety of prophylactic metoclopramide for elective cesarean delivery during spinal anesthesia.Reg Anesth. 1992; 17: 126-130PubMed Google Scholar 10Biswas BN Rudra A Das SK Nath S Biswas SC A comparative study of glycopyrrolate, dexamethasone and metoclopramide in control of post-operative nausea and vomiting after spinal anaesthesia for caesarean delivery.Indian J Anaesth. 2003; 47: 198-200Google Scholar 12Danzer BI Birnbach DJ Stein DJ Kuroda MM Thys DM Does
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