Control of nausea and vomiting in women undergoing cesarean section with spinal anesthesia: A narrative review study on the role of drugs

Spinal anesthesia is the most common method of analgesia for elective cesarean section. Postoperative nausea and vomiting is one of the most common complaints of patients in cesarean section under spinal anesthesia, so this study was performed with aim to investigate the role of drugs in controlling nausea and vomiting in women undergoing cesarean section with spinal anesthesia.

In this narrative review study, to find the related articles, databases of SID, Magiran, and Google Scholar were searched with the keywords of spinal anesthesia, nausea, vomiting, and cesarean section. The time period for searching articles was from 2001 to 2021.

Different studies have used different medications to prevent nausea and vomiting after cesarean section. Nausea and vomiting after spinal anesthesia has been the specific goal of many studies with clinical trial design. The performed interventions in this regard included: use of drugs such as Dexamethasone, Ketamine, Lidocaine, Ondansetron, Metoclopramide, Granistron, Propofol, Gabapentin and Midazolam.

Although the anti-nausea and anti-emetic effect of ketamine has been approved in the studies, it is best not to be the first choice of an anesthesiologist because of the effects of hallucinations and nystagmus and the fact that it may delay breastfeeding. Propofol has also been shown to have anti-nausea and anti-emetic effects, but we must be careful about the effects of the patient's respiratory depression. Dexamethasone has a delaying effect on nausea and vomiting, so it may not be a good choice for an anesthesiologist. 5-HT3 receptor antagonists (ondansetron and granisetron) seem to be the best choice for first-line treatment of nausea and vomiting. Because these drugs do not have the extrapyramidal side effects of metoclopyramide and can be used as appropriate drugs for nausea and vomiting in patients undergoing cesarean section with spinal anesthesia.