Midazolam deep sedation versus metoclopramide to prevent nausea and vomiting during small dose bupivacaine spinal anesthesia for cesarean section

ABSTRACT

Nausea and vomiting during regional anesthesia for Cesarean section are very common and unpleasant events. They cause significant distress to the patient and also interfere with the surgical procedure. They have multiple etiologies, which include psychological [anxiety] factor, arterial hypotension, and hypo perfusion of the central nervous system. The trials for prevention and treatment of IONV still not definite. In the present study we evaluate the efficacy of hypnotic doses of midazolam in comparison with metoclopramide to prevent nausea and vomiting during spinal anesthesia for elective Cesarean section. One hundred [100] pregnant females were divided to two groups. Group [A] receives [midazolam, n=50], Group [B] receives [metoclopramide, n= 50], the two groups received spinal anesthesia with 8 mg of bupivacaine to avoid sever hypotension and decrease incidence of nausea and vomiting. Nausea and vomiting occurred in 5% of the total cases. IONV was absent in 97% in the midazolam group, 96% in metoclopramida group [p <0.001] for both group, no significant difference between two groups. The results showed a significant lower incidence of IONV in the deep sedation with midazolam and metoclopramide, without significant difference between two groups. The results confirmed and explained that, IONV during spinal anesthesia for Cesarean Section can be caused by psychological [anxiety] factors