Sub-hypnotic dose of propofol as antiemetic prophylaxis attenuates intrathecal morphine-induced postoperative nausea and vomiting, and pruritus in parturient undergoing cesarean section — a randomized control trial

Abstract

Background Postoperative Nausea and Vomiting (PONV) is a dreadful and uncomfortable experience that significantly detracts patients’ quality of life after surgery. This study aimed to examine the antiemetic effect of a single sub-hypnotic dose of propofol as prophylaxis for PONV. Method In this prospective, double-blind, randomized control trial, 345 parturients presented for elective cesarean section at the Obstetric unit of Tamale Teaching Hospital were recruited. Each recruited parturient was randomly assigned to one of three groups; Propofol group (n = 115) represented those who received propofol 0.5 mg/kg, Metoclopramide group (n = 115) represented those who received metoclopramide 10 mg and, Control group (n = 115) represented those who received 0.9% saline. Spinal anesthesia with 0.5% hyperbaric bupivacaine 7.5–10 mg, and intrathecal morphine 0.2 mg was employed for the anesthesia. Results The data indicate that 108 (93.9%) parturients from the control group, 10 (8.7%) from the propofol group and 8 (7.0%) from the metoclopramide group experienced some incidence of PONV. There was no significant difference in the incidence of PONV (nausea, vomiting, and none) between the propofol and the metoclopramide groups (P = 0.99; 0.31; and 0.35 respectively). Parturients who received antiemetic agents were 105 (97.2%), 1 (10.0%) and 3 (37.5%) from the control, propofol and metoclopramide groups respectively. The data indicated that 98 (85.2%) parturients from the control, 3 (2.6%) from propofol group, and 100 (87.0%) from the metoclopramide group experienced some levels of pruritus. There was a significant difference in the incidence of pruritus (mild, moderate, and no pruritus) between the metoclopramide and propofol groups (P < 0.01; P < 0.01; and P < 0.01 respectively). Conclusion A sub-hypnotic dose of propofol is effective as metoclopramide in the prevention of PONV in parturient undergoing cesarean section under spinal anesthesia with intrathecal morphine. Sub-hypnotic dose of propofol significantly reduces the incidence of postoperative pruritus following intrathecal morphine use. Trial registration Current control trial, registered at ISRCTN trial registry: ISRCTN15475205. Date registered: 03/04/2019. Retrospectively registered.

The Effect of Different Anesthesia Techniques on Strabismus Surgery: A Prospective Observational Study

“…Kranke et al ( 16) also reported that when propofol was utilized for strabismus surgery anesthesia, there was less PONV than inhalation agents. Some authors report that propofol has the same as metoclopramide, an antiemetic agent, at sub-hypnotic doses (17). The mechanism of this effect is not precise.…”

“…It has been postulated to be an antagonist at the 5HT3 receptor. Other reports suggest that the anti-emetic effect of propofol is due to modulation of the subcortical pathways (16,17). In many recent reports, propofol should be the first choice among anesthetic agents, especially since it prevents the development of PONV in strabismus surgery of pediatric patients (18).…”

Pharmacologic interventions for postoperative nausea and vomiting after thyroidectomy: A systematic review and network meta-analysis

“…These results are supported by a previous report which demonstrated that propofol was efficacious in treating PONV at plasma concentrations that do not produce increased sedation [ 77 ]. It is also reported that propofol given for elective cesarean section under spinal anesthesia at sub-hypnotic doses decreased the incidence of PONV without unwanted sedative and respiratory or cardiovascular side effects [ 78 ]. Although the exact mechanism by which propofol prevents emesis is unknown, antagonism of the dopaminergic [ 26 ] and serotonergic pathways, modulation of the subcortical pathways [ 79 ], and direct depressant effect on the chemoreceptor trigger zone, the vagal nuclei, and other centers [ 80 ] were suggested as possible antiemetic mechanisms.…”

Neuroaxiale Gabe von Morphin nach Sectio caesarea: ein Update

“…Zur Vorbeugung bzw. Behandlung dieser unerwünschten und für die Patientinnen teilweise belastenden Wirkungen werden empfohlen: ▪ Ondansetron [38,39] [43,44] und ▪ Propofol [44,45].…”