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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2011 Agosto;77(8):781-8
Intrathecal atropine to prevent postoperative nausea and vomiting after Cesarean section: a randomized, controlled trial
Baciarello M. 1, Cornini A. 1, Zasa M. 1, Pedrona P. 1, Scrofani G. 2, Venuti F. S. 2, Fanelli G. 1 ✉
1 Department of Anesthesiology, Critical Care and Pain Medicine, University Hospital of Parma, Parma, Italy;
2 Department of Neuroscience, Psychiatric and Anesthesiological Science, University of Messina, Messina, Italy
BACKGROUND:Postoperative nausea and vomiting (PONV) is a common adverse effect of intrathecal morphine, especially after Cesarean section. This randomized controlled trial investigated the effects of intrathecal administration of a small-dose of atropine on postoperative nausea and vomiting after Cesarean section.
METHODS: Parturients with ASA physical status class I-II scheduled for elective Cesarean section and consenting to spinal anesthesia were enrolled. They received 0.5% hyperbaric bupivacaine 12.5 mg, morphine 200 µg and one of the following three solutions: atropine 100 µg intrathecally and saline intravenously; saline intrathecally and atropine 100 µg intravenously; saline only both intravenously and intrathecally. We examined the incidence and severity of PONV, pain ratings and the need for analgesics.
RESULTS:We followed 204 parturients. The incidence of PONV was 15%, 37% and 49% in the three groups, respectively (P<0.001). The relative risk reduction for PONV when using intrathecal atropine was 69% vs. placebo and 59% vs. intravenous atropine. No differences were noted in terms of postoperative pain.
CONCLUSION: Intrathecal atropine had a significant antiemetic effect, making it a useful adjunct for intrathecal opioid-related PONV.