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Dexamethasone prophylaxis of nausea and vomiting after epidural morphine for post-Cesarean analgesia

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Abstract

Purpose: To determine the minimum effective dose of dexamethasone in preventing nausea and vomiting associated with epidural morphine for post-Cesarean analgesia.

Method: One hundred and eighty parturients (n=45 in each of four groups) requiring epidural morphine for post-Cesarean analgesia were enrolled in this randomized, double-blinded, placebo-controlled study. At the end of surgery, parturients received either dexamethasone, at doses of 10 mg, 5 mg, 2.5 mg, or salineiv. Three milligrams epidural morphine were given to all parturients for postoperative analgesia. The incidence of PONV and side effects were estimated for 24 hr after delivery by blinded, trained nurse anesthetists.

Results: Parturients who received dexamethasone, either 10 mg or 5 mg were different from those who received saline alone in the following parameters: the total incidence of nausea and vomiting, incidence of >4 vomiting episodes, number the of parturients requiring rescue antiemetics, and the total number of parturients with no vomiting and/or no antiemetic medication (P<0.05 toP<0.01). The differences between dexamethasone 10 mg and 5 mg were not significant. Dexamethasone 2.5 mg was partially effective.

Conclusion: Dexamethasone, 5 mgiv, is suggested as the minimum effective dose in preventing nausea and vomiting associated with epidural morphine for post-Cesarean analgesia.

Résumé

Objectif: Déterminer la dose efficace minimale de dexaméthasone à utiliser pour prévenir les nausées et les vomissements liés à l’administration épidurale de morphine comme analgésie post-césarienne.

Méthode: Cent quatre-vingt parturientes (n=45 dans chacun des quatre groupes), nécessitant une analgésie épidurale post-césarienne avec morphine, ont participé à l’étude randomisée et à double insu contre placebo. Elles ont reçu, à la fin de l’opération, soit 10 mg, 5 mg ou 2,5 mg de dexaméthasone, soit une solution saléeiv. Toutes ont reçu 3 mg de morphine comme analgésie postopératoire épidurale. L’incidence des NVPO et des effets secondaires a été évaluée pendant vingt-quatre heures après l’accouchement par des infirmières impartiales diplômées en anesthésie.

Résultats: Les parturientes qui ont reçu 10 mg ou 5 mg de dexaméthasone ont présenté des caractéristiques différentes de celles qui ont reçu le placebo pour les paramètres suivants: l’incidence totale de nausées et de vomissements, l’incidence d’épisodes de vomissements >4, le nombre de patientes qui ont eu besoin d’antiémétiques de secours et le nombre total de parturientes sans vomissements et/ou sans médication antiémétique (P<0,05àP<0,01). Aucune différence significative n’était liée aux doses de 10 mg et de 5 mg de dexaméthasone. La dexaméthasone à 2,5 mg n’a été que partiellement efficace.

Conclusion: La dexaméthasone, administrée en doses de 5 mgiv, est suggérée comme la dose efficace minimale pour prévenir les nausées et les vomissements associés à l’analgésie épidurale post-césarienne avec de la morphine.

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Author information

Correspondence to Jhi-Joung Wang.

Additional information

The work was done in the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

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Wang, J., Ho, S., Wong, C. et al. Dexamethasone prophylaxis of nausea and vomiting after epidural morphine for post-Cesarean analgesia. Can J Anaesth 48, 185 (2001). https://doi.org/10.1007/BF03019733

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Keywords

  • Morphine
  • Dexamethasone
  • Ondansetron
  • Droperidol
  • Postoperative Nausea