Intrathecal atropine versus intravenous metoclopramide for prevention of nausea and vomiting during cesarean section under spinal anesthesia

Background One of the most unpleasant sensation is the occurrence of intraoperative episodes of nausea and vomiting in mothers undergoing cesarean section (CS) under spinal anesthesia.Objective The aim of the present study was to compare the use of prophylactic low-dose atropine in comparison with the effect of metoclopramide for prevention of perioperative nausea and vomiting in mothers undergoing CS under spinal anesthesia.Patients and methods The present study was conducted in 60 full-term mothers of American Society of Anesthesiology Grade I and II, with age between 20 and 35 years with uncomplicated pregnancies. Patients were allocated into two equal groups. Atropine group (group A) included 30 patients who received intrathecal study solution which is a mixture of 2.5 ml of 0.5% hyperbaric bupivacaine, 25 μg fentanyl, and 100 μg of a 1 mg/ml of free atropine sulfate. Metoclopramide group (group M) included 30 patients who received intravenous solution of metoclopramide 10 mg in 2 ml in addition to intrathecal study solution (2.5 ml of 0.5 hyperbaric bupivacaine, 25 μg fentanyl and 100 μg of preservative-free saline 0.9% as a placebo) which was given after spinal anesthesia and before the start of surgical incision. The number of episodes of nausea and vomiting were recorded, and also any other adverse effects were recorded.Results The incidence of intraoperative nausea and vomiting (IONV) and late nausea score were significantly decreased in group A compared with group M (P<0.05), and nearly equal incidence in early onset of nausea in both groups. No differences were noted in terms of postoperative pain or hypotensive episodes.Conclusion Intrathecal atropine can be safely used to decrease intraoperative nausea and vomiting for mothers undergoing CS under spinal anesthesia.