Does metoclopramide supplement postoperative analgesia using patient-controlled analgesia with morphine in patients undergoing elective cesarean delivery?

BACKGROUND AND OBJECTIVES: Recent studies have shown that metoclopramide may decrease postoperative narcotic requirements in patients undergoing second-trimester induced abortions or prosthetic hip surgery. It is often used to decrease the incidence of nausea and vomiting in the patient undergoing cesarean delivery under regional anesthesia. If metoclopramide were found to be an analgesic adjunct in these patients, it would offer an additional impetus for its routine use. METHODS: After elective cesarean delivery under spinal anesthesia, 32 patients were monitored for initial and 24-hour postoperative morphine requirements via intravenous patient-controlled analgesia. These patients were divided into two groups. Prior to spinal block, group 1 (n = 17) received 10 mg intravenous metoclopramide, and group 2 (n = 15) received an intravenous saline placebo. RESULTS: No differences were found between groups in the time from spinal placement to the time of pain onset, the amount of morphine necessary to initially achieve comfort, or 24-hour postoperative morphine requirements. (P > .05). CONCLUSIONS: This study demonstrates that metoclopramide decreases intraoperative nausea but does not supplement analgesia in patients undergoing elective cesarean delivery.

Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section.

Nausea and vomiting occur frequently during cesarean section under spinal anesthesia. Metoclopramide reduces intraoperative nausea and vomiting, but not without potential side effects. Acupressure, a noninvasive variation of acupuncture that involves constant pressure on the wrist, has been suggested as an alternative method to prevent nausea and vomiting. The aim of this study was to compare acupressure and intravenous (IV) metoclopramide for the prevention of nausea and vomiting during elective cesarean section under spinal anesthesia. Seventy-five patients were studied in a randomized, prospective, double-blind comparative trial. Group I patients received acupressure bands + 2 mLIV saline, Group II patients received placebo wrist bands + 10 mg IV metoclopramide, and Group III patients received placebo wrist bands + 2 mL IV saline. Patients who received either acupressure or metoclopramide prior to initiation of spinal anesthesia for cesarean section had much less nausea than patients in the placebo group. Acupressure is an effective, non-pharmacologic method to reduce intraoperative nausea during elective cesarean section in the awake patient.

Cocaine screening of parturients without prenatal care: an evaluation of a rapid screening assay.

Illicit drugs are used widely by inner city patients in our society. Because cocaine ingestion can produce life-threatening arrhythmias and interact with anesthetic drugs, it is potentially useful for the anesthesiologist to know a high-risk patient's cocaine status before administering anesthesia. The commonly used methods to detect cocaine abuse, however, often require 1-3 days for laboratory processing. With these tests, anesthesiologists are unable to test for recent cocaine use in an emergency setting. A new rapid latex agglutination assay for urinary metabolites of cocaine (OnTrak Abuscreen; Roche Diagnostic Systems Inc., Branchburg, NJ) was compared with an assay used by many hospital laboratories. The prevalence of cocaine abuse in the group of unregistered parturients was found to be 68%, with the latex agglutination results exactly matching the hospital laboratory results (kappa = 1.0). A sensitive and specific method now exists that allows anesthesiologists to assess cocaine use rapidly, so that they can use this information when planning a patient's anesthetic.

Anesthesia for the parturient with sickle cell disease.

A brief overview of the genetics, transmission, pathophysiology, and clinical manifestations of sickle cell disease is presented. Issues and management dilemmas specific to the parturient with sickle cell disease are discussed, along with recommendations regarding preoperative, operative, and postoperative care. Three case reports from our institution are used to illustrate problems that may occur in these patients.