Factors associated with postoperative nausea or vomiting in parturients undergoing caesarean delivery under spinal anaesthesia with intrathecal morphine

BACKGROUND: Nowadays, spinal anaesthesia is a suitable choice for most elective and emergency cesarean section (C-section) deliveries. AIM: This study aimed to determine the effect of adding low-dose naloxone to intrathecal morphine on postoperative pain and morphine related side effects after C-section. MATERIAL AND METHODS: In the present double-blind, randomised clinical trial, 70 women aged over 18 years, who were candidates for elective medical C-section under spinal anaesthesia were selected and randomly assigned to either the study group or the control group. For spinal anaesthesia, 10 mg of Bupivacaine plus 100 μg of morphine was administered for all patients. However, patients in the study group received 20 µg of naloxone intrathecally; but the patients in the control group only received normal saline as a placebo. After surgery, patient-controlled analgesia (PCA) pump with paracetamol (Apotel®) was connected to each patient. The intensity of postoperative pain in the patients was evaluated and recorded using Visual Acuity Screening (VAS) at 2, 4, 6 and 24 hours after the surgery. The patients were also examined for postoperative nausea and pruritus. RESULTS: Regardless of the groups to which the patients were assigned, a significant difference in pain intensity was observed during the study period (time effect; p < 0.001). Although the intensity of pain was lower in the study group, the difference was not statistically significant (group effect; p = 0.84). Also, there was no group time interaction between pain intensity and the times studied (p = 0.61). The incidence rates of postoperative nausea and pruritus were significantly lower in the study group compared to the control group (p < 0.001). CONCLUSION: According to the results of this study, adding low dose naloxone to intrathecal morphine did not significantly change postoperative pain intensity in the patients undergone elective C-section using spinal anaesthesia; however, significantly decreased the severity of postoperative nausea and pruritus.

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Heart rate variability and haemodynamic factors associated with hypotension during spinal anaesthesia for caesarean delivery

European Journal of Anaesthesiology ◽

10.1097/eja.0000000000001551 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Emma Wei Du ◽

Hon Sen Tan ◽

Chin Wen Tan ◽

Rehena Sultana ◽

Ban Leong Sng

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Spinal Anaesthesia ◽

Caesarean Delivery ◽

Factors Associated

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Pruritus and postoperative nausea and vomiting after intrathecal morphine in spinal anaesthesia for Total Knee Replacement: Prospective cohort study

10.26226/morressier.5d1cc24a57558b317a173403 ◽

2019 ◽

Author(s):

Rahiman Abd Rahim ◽

Viera Husarova ◽

Viera ['Rob'] ◽

Das Gurmukh

Keyword(s):

Cohort Study ◽

Total Knee Replacement ◽

Knee Replacement ◽

Prospective Cohort Study ◽

Spinal Anaesthesia ◽

Postoperative Nausea ◽

Prospective Cohort ◽

Intrathecal Morphine ◽

Postoperative Nausea And Vomiting ◽

Total Knee

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Risk of postoperative nausea and vomiting in hip and knee arthroplasty: a prospective cohort study after spinal anaesthesia including intrathecal morphine

BMC Anesthesiology ◽

10.1186/s12871-020-01154-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Antonio Moraitis ◽

Magnus Hultin ◽

Jakob Walldén

Keyword(s):

Cohort Study ◽

Spinal Anaesthesia ◽

Postoperative Nausea ◽

Intrathecal Morphine ◽

Univariate Analysis ◽

Postoperative Nausea And Vomiting ◽

Female Gender ◽

Nausea And Vomiting ◽

Number Of Patients ◽

Hip And Knee Arthroplasty

Abstract Background The overall risk of postoperative nausea and vomiting after general anaesthesia is approximately 30% even with prophylactic medications. Studies exploring the risk after regional anaesthesia including intrathecal morphine are limited but indicate that intrathecal morphine is highly emetogenic and is additive to the PONV risk associated with other forms of anaesthesia. The aim of this observational study was to investigate the risk of PONV after spinal blockade combined with intrathecal morphine and to explore associations with patient and perioperative factors, including given PONV-prophylaxis. We hypothesized that a large number of patients in a clinical setting receive less prophylaxis than the recommendations in guidelines (suboptimal prophylaxis), leading to a higher risk for PONV compared to those receiving adequate PONV prophylaxis. Methods The study was conducted as a prospective observational cohort study regarding PONV in patients undergoing hip/knee replacement under spinal anaesthesia including intrathecal morphine. Patients were included at a county hospital in Sweden during April–November 2013 (n = 59) and September 2014–June 2015 (n = 40). One hundred eight patients entered the study with 99 patients analysed in the final cohort. Patients were followed the first three postoperative days with a questionnaire regarding PONV and peri- and postoperative data was collected. PONV risk is presented as the proportion of patients (%) with PONV and was related to the level of perioperative PONV-prophylaxis (suboptimal/optimal). Univariate analysis was used to analyse factors associated with PONV. Results Forty-six patients (46%) experienced PONV during the 3-day study period whereof 36 patients (36%) until noon the first day after the procedure. 19/27 patients (70%) that received suboptimal PONV-prophylaxis experienced PONV compared to 27/72 (38%) that received optimal PONV-prophylaxis (p = 0.015). Further, female gender and/or a history of motion sickness were associated with an increased PONV-risk. Conclusions There was a high risk for PONV after spinal anaesthesia including morphine. PONV risk was associated with the level of prophylaxis and with known risk factors for PONV. Our findings suggest that a more liberal use of PONV prophylaxis might be motivated.

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