Intrathecal atropine to prevent postoperative nausea and vomiting after Cesarean section: a 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 µg and one of the following three solutions: atropine 100 µg intrathecally and saline intravenously; saline intrathecally and atropine 100 µg 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.

[1]  A. Habib,et al.  Serotonin Receptor Antagonists for the Prevention and Treatment of Pruritus, Nausea, and Vomiting in Women Undergoing Cesarean Delivery with Intrathecal Morphine: A Systematic Review and Meta-Analysis , 2009, Anesthesia and analgesia.

[2]  M. Tryba,et al.  Risks and side‐effects of intrathecal morphine combined with spinal anaesthesia: a meta‐analysis , 2009, Anaesthesia.

[3]  S. Inoue,et al.  A comparison of morphine concentrations for patient-controlled epidural analgesia following gynecological surgery. , 2009, Minerva anestesiologica.

[4]  P. Girard,et al.  Modulation of Paracetamol and Nefopam Antinociception by Serotonin 5-HT3 Receptor Antagonists in Mice , 2009, Pharmacology.

[5]  M. Allegri,et al.  Comparing the efficacy and safety of continuous epidural analgesia in abdominal and urological surgery between two opioids with different kinetic properties: morphine and sufentanyl. , 2008, Minerva anestesiologica.

[6]  S. Segal,et al.  Transdermal Scopolamine for Prevention of Intrathecal Morphine-Induced Nausea and Vomiting After Cesarean Delivery , 2007, Anesthesia and analgesia.

[7]  P. Tan,et al.  Prevention of postoperative nausea and vomiting after intrathecal morphine for Cesarean section: a randomized comparison of dexamethasone, droperidol, and a combination. , 2007, International journal of obstetric anesthesia.

[8]  W. Kirch,et al.  Pharmacokinetics and Pharmacodynamics in Clinical Use of Scopolamine , 2005, Therapeutic drug monitoring.

[9]  M. Balki,et al.  Intraoperative nausea and vomiting during cesarean section under regional anesthesia. , 2005, International journal of obstetric anesthesia.

[10]  K. Ho,et al.  Use of Intrathecal Neostigmine as an Adjunct to Other Spinal Medications in Perioperative and Peripartum Analgesia: A Meta-analysis , 2005, Anaesthesia and intensive care.

[11]  K. Koga,et al.  The spinal muscarinic receptor subtypes contribute to the morphine-induced antinociceptive effects in thermal stimulation in mice , 2004, Neuroscience Letters.

[12]  D. Buggy,et al.  Prevention of postoperative nausea and vomiting after spinal morphine for Caesarean section: comparison of cyclizine, dexamethasone and placebo. , 2003, British journal of anaesthesia.

[13]  J. Wess,et al.  Muscarinic receptor subtypes mediating central and peripheral antinociception studied with muscarinic receptor knockout mice: a review. , 2003, Life sciences.

[14]  A. Kovac.  Prevention and Treatment of Postoperative Nausea and Vomiting , 2000, Drugs.

[15]  I. Jeyapalan,et al.  Central neuraxial opioid analgesia after caesarean section: comparison of epidural diamorphine and intrathecal morphine. , 1999, International journal of obstetric anesthesia.

[16]  T. Fuchs-Buder,et al.  Omitting antagonism of neuromuscular block: effect on postoperative nausea and vomiting and risk of residual paralysis. A systematic review. , 1999, British journal of anaesthesia.

[17]  A. Chhibber,et al.  Effects of anticholinergics on postoperative vomiting, recovery, and hospital stay in children undergoing tonsillectomy with or without adenoidectomy. , 1999, Anesthesiology.

[18]  M. Douglas,et al.  Acupressure for intrathecal narcotic-induced nausea and vomiting after caesarean section. , 1998, International journal of obstetric anesthesia.

[19]  J F Golding,et al.  Comparison of the effects of a selective muscarinic receptor antagonist and hyoscine (scopolamine) on motion sickness, skin conductance and heart rate. , 1997, British journal of clinical pharmacology.

[20]  D. Amici,et al.  Central antiemetic effect of atropine: our personal experience , 1996, Canadian Journal of Anaesthesia-journal Canadien D Anesthesie.

[21]  M. Schwartz,et al.  Epidural scopolamine administration in preventing nausea after epidural morphine. , 1995, Journal of clinical anesthesia.

[22]  N. Pace,et al.  Dose‐Response Pharmacology of Intrathecal Morphine in Human Volunteers , 1993, Anesthesiology.

[23]  E. Ellinwood,et al.  Comparison of central nervous system and peripheral pharmacodynamics to atropine pharmacokinetics. , 1990, The Journal of pharmacology and experimental therapeutics.

[24]  S. Hyman,et al.  Pseudocholinesterase Activity in Human Cerebrospinal Fluid , 1989, Anesthesia and analgesia.

[25]  R. Cogan,et al.  Pain and discomfort thresholds in late pregnancy , 1986, Pain.

[26]  R. Clarke,et al.  ANAESTHESIA AND PREMEDICATION AS FACTORS IN POSTOPERATIVE VOMITING , 1965, Acta anaesthesiologica Scandinavica.

[27]  S. Peroutka,et al.  Differentiation of muscarinic cholinergic receptor subtypes in human cortex and pons: implications for anti-motion sickness therapy. , 1988, Aviation, space, and environmental medicine.