Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section
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Mohammadreza Bozorgmanesh
Abstract
Objectives
Postoperative nausea and vomiting (PONV) are common symptoms after cesarean delivery (CD) that affect patients outcomes and satisfaction. The treatment of choice is still evolving, therefore, we aimed to evaluate PONV of combined paracetamol-dexamethasone vs. paracetamol alone.
Methods
This study is a double-blind randomized controlled trial on 100 patients undergoing cesarean delivery. Participants were randomly assigned into two groups of paracetamol or combined paracetamol-dexamethasone. Nausea and vomiting score, VAS score of pain, and chill were compared between the two groups.
Results
The result of this study found that mild nausea 2nd h after surgery in the combined group was lesser than paracetamol group (0.03). However, there was no statistically significant difference in nausea and vomiting score in other periods of time between the two groups. VAS score of pain decreased 12th and 6th h after the surgery in the combined and paracetamol group, respectively. Chilling occurred in two patients of combined group and four patients of paracetamol group (p=0.432).
Conclusions
Dexamethasone added to paracetamol might not improve pain and vomiting after cesarean delivery comparison with just paracetamol. But it can be effective for reducing the score of nausea after the surgery.
Acknowledgments
The authors would like to express their gratitude to Fatemeh Rafiei for her assisting of data analysis.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: This study was approved by the ethics committee of Arak University of Medical Sciences with the ethical code IR.ARAKMU.REC.1399.290. The approval code of Iranian Registry of Clinical Trials was IRCT20201028049175N6.
References
1. Macones, GA, Caughey, AB, Wood, SL, Wrench, IJ, Huang, J, Norman, M, et al.. Guidelines for postoperative care in cesarean delivery: enhanced recovery after surgery (ERAS) society recommendations (part 3). Am J Obstet Gynecol 2019;221:247. e1–9.10.1016/j.ajog.2019.04.012Search in Google Scholar PubMed
2. Tan, HS, Habib, AS. The optimum management of nausea and vomiting during and after cesarean delivery. Best Pract Res Clin Anaesthesiol 2020;34:735–47.10.1016/j.bpa.2020.04.012Search in Google Scholar PubMed
3. Bernstein, J, Spitzer, Y, Ohaegbulam, K, Reddy, S, Song, J, Romanelli, E, et al.. The analgesic efficacy of IV acetaminophen for acute postoperative pain in C-section patients: a randomized, double-blind, placebo-controlled study. J Matern Fetal Neonatal Med 2020;35:1–8.10.1080/14767058.2020.1735337Search in Google Scholar PubMed
4. Ho, C-M, Wu, H-L, Ho, S-T, Wang, J-J. Dexamethasone prevents postoperative nausea and vomiting: benefit versus risk. Acta Anaesthesiol Taiwanica 2011;49:100–4.10.1016/j.aat.2011.06.002Search in Google Scholar PubMed
5. Shahid, M, Manjula, B, Sunil, B. A comparative study of intravenous paracetamol and intravenous tramadol for postoperative analgesia in laparotomies. Anesth Essays Res 2015;9:314.10.4103/0259-1162.158005Search in Google Scholar PubMed PubMed Central
6. Holte, K, Kehlet, H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg 2002;195:694–712.10.1016/S1072-7515(02)01491-6Search in Google Scholar PubMed
7. Apfel, CC, Turan, A, Souza, K, Pergolizzi, J, Hornuss, C. Intravenous acetaminophen reduces postoperative nausea and vomiting: a systematic review and meta-analysis. Pain® 2013;154:677–89.10.1016/j.pain.2012.12.025Search in Google Scholar PubMed
8. De Oliveira, GSJr., Castro-Alves, LJ, McCarthy, RJ. Single-dose systemic acetaminophen to prevent postoperative pain: a meta-analysis of randomized controlled trials. Clin J Pain 2015;31:86–93.10.1097/AJP.0000000000000081Search in Google Scholar PubMed
9. Altenau, B, Crisp, CC, Devaiah, CG, Lambers, DS. Randomized controlled trial of intravenous acetaminophen for postcesarean delivery pain control. Am J Obstet Gynecol 2017;217:362. e1–6.10.1016/j.ajog.2017.04.030Search in Google Scholar PubMed
10. Rawlinson, A, Kitchingham, N, Hart, C, McMahon, G, Ong, SL, Khanna, A. Mechanisms of reducing postoperative pain, nausea and vomiting: a systematic review of current techniques. BMJ Evid Based Med 2012;17:75–80.10.1136/ebmed-2011-100265Search in Google Scholar PubMed
11. Ayu, D, Widowati, AS, Riza, M. Effect of combined paracetamol and dexamethasone on pain and postoperative nausea vomiting. Int J Hum Health Sci 2020;4:184–8.10.31344/ijhhs.v4i3.198Search in Google Scholar
12. Agarkar, S, Chatterjee, AS. Comparison of ramosetron with ondansetron for the prevention of post-operative nausea and vomiting in high-risk patients. Indian J Anaesth 2015;59:222.10.4103/0019-5049.154999Search in Google Scholar PubMed PubMed Central
13. Aluri, S, Wrench, I. Enhanced recovery from obstetric surgery: a UK survey of practice. Int J Obstet Anesth 2014;23:157–60.10.1016/j.ijoa.2013.11.006Search in Google Scholar PubMed
14. Taniguchi, H, Nagahuchi, M, Kamada, T, Suga, K, Sato, T, Ueda, T, et al.. Effect of scheduled intravenous acetaminophen on postoperative nausea and vomiting in patients undergoing laparoscopic gynecologic surgery. J Anesth 2020;34:502–11.10.1007/s00540-020-02777-9Search in Google Scholar PubMed
15. Ozmete, O, Bali, C, Cok, OY, Ergenoglu, P, Ozyilkan, NB, Akin, S, et al.. Preoperative paracetamol improves post-cesarean delivery pain management: a prospective, randomized, double-blind, placebo-controlled trial. J Clin Anesth 2016;33:51–7.10.1016/j.jclinane.2016.02.030Search in Google Scholar PubMed
16. Patel, MS, Abboud, JA, Sethi, PM. Perioperative pain management for shoulder surgery: evolving techniques. J Shoulder Elbow Surg 2020;29:e416–33.10.1016/j.jse.2020.04.049Search in Google Scholar PubMed
17. Hassan, HIEA. Perioperative analgesic effects of intravenous paracetamol: preemptive versus preventive analgesia in elective cesarean section. Anesth Essays Res 2014;8:339.10.4103/0259-1162.143135Search in Google Scholar PubMed PubMed Central
18. Andrews, P, Rapeport, W, Sanger, G. Neuropharmacology of emesis induced by anti-cancer therapy. Trends Pharmacol Sci 1988;9:334–41.10.1016/0165-6147(88)90106-XSearch in Google Scholar PubMed
19. Bountra, C, Gale, J, Gardner, C, Jordan, C, Kilpatrick, G, Twissell, D, et al.. Towards understanding the aetiology and pathophysiology of the emetic reflex: novel approaches to antiemetic drugs. Oncology 1996;53:102–9.10.1159/000227649Search in Google Scholar PubMed
20. Wang, J-J, Ho, S-T, Lee, S-C, Liu, Y-C, Liu, Y-H, Liao, Y-C. The prophylactic effect of dexamethasone on postoperative nausea and vomiting in women undergoing thyroidectomy: a comparison of droperidol with saline. Anesth Analg 1999;89:200–3.10.1213/00000539-199907000-00036Search in Google Scholar
21. Henzi, I, Walder, B, Tramer, MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 2000;90:186–94.10.1097/00000539-200001000-00038Search in Google Scholar PubMed
22. Jelting, Y, Klein, C, Harlander, T, Eberhart, L, Roewer, N, Kranke, P. Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions. Local Reg Anesth 2017;10:83.10.2147/LRA.S111459Search in Google Scholar PubMed PubMed Central
23. Griffiths, JD, Gyte, GM, Popham, PA, Williams, K, Paranjothy, S, Broughton, HK, et al.. Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section. Cochrane Database Syst Rev 2021;5:CD007579. https://doi.org/10.1002/14651858.CD007579.Search in Google Scholar
24. Selzer, A, Pryor, KO, Tangel, V, O’Connell, K, Kjaer, K. The effect of intravenous dexamethasone on postoperative nausea and vomiting after cesarean delivery with intrathecal morphine: a randomized-controlled trial. Can J Anaesth 2020;67:817–26.10.1007/s12630-020-01582-ySearch in Google Scholar PubMed
25. Sane, S, Hasanlui, MV, Abbasivash, R, Mahoori, A, Hashemi, ST, Rafiei, F. Comparing the effect of intravenous dexamethasone, intravenous ondansetron, and their combination on nausea and vomiting in cesarean section with spinal anesthesia. Adv Biomed Res 2015;4.10.4103/2277-9175.167030Search in Google Scholar PubMed PubMed Central
© 2022 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- WAPM Guideline
- Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation
- Original Articles – Obstetrics
- Racial and ethnic distribution of US randomized controlled trials in obstetrics: a retrospective review
- Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes
- Variations in uterine closure technique: an institutional survey of obstetricians and implications for patient counseling and prevention of adverse sequelae
- Termination of pregnancy in the second trimester – the course of different therapy regimens
- Hyponatremia among preeclampsia patients – a potential sign of severity
- Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section
- Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial
- Does the use of chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A databased historical cohort study
- The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies
- Evaluating the correlation between amniotic fluid volume and estimated fetal weight in healthy pregnant women
- Metabolic characterization of amniotic fluid of fetuses with isolated choroid plexus cyst
- Does a cervical pessary reduce the rate of preterm birth in women with a short cervix?
- Research progress on N6-methyladenosine in the human placenta
- Why are women deciding against birth in alongside midwifery units? A prospective single-center study from Germany
- Pregnancy hypothyroidism incidence and complications using the 2011 and 2017 ATA cutoff values. Experience at a maternity hospital in a densely populated area in Mexico City
- Expression pattern and clinical significance of microRNA-let-7a and IFN-gamma in placental tissue of patients with preeclampsia with severe features
- Original Articles – Fetus
- Management of neonates with 35 weeks of gestational age or more with infectious risk factors at birth: opportunities for improvement
Articles in the same Issue
- Frontmatter
- WAPM Guideline
- Ultrasound in labor: clinical practice guideline and recommendation by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation
- Original Articles – Obstetrics
- Racial and ethnic distribution of US randomized controlled trials in obstetrics: a retrospective review
- Impact of earlier gestational diabetes screening for pregnant people with obesity on maternal and perinatal outcomes
- Variations in uterine closure technique: an institutional survey of obstetricians and implications for patient counseling and prevention of adverse sequelae
- Termination of pregnancy in the second trimester – the course of different therapy regimens
- Hyponatremia among preeclampsia patients – a potential sign of severity
- Effect of combined paracetamol and dexamethasone vs. paracetamol on postoperative nausea vomiting after cesarean section
- Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial
- Does the use of chitosan covered gauze for postpartum hemorrhage reduce the need for surgical therapy including hysterectomy? A databased historical cohort study
- The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies
- Evaluating the correlation between amniotic fluid volume and estimated fetal weight in healthy pregnant women
- Metabolic characterization of amniotic fluid of fetuses with isolated choroid plexus cyst
- Does a cervical pessary reduce the rate of preterm birth in women with a short cervix?
- Research progress on N6-methyladenosine in the human placenta
- Why are women deciding against birth in alongside midwifery units? A prospective single-center study from Germany
- Pregnancy hypothyroidism incidence and complications using the 2011 and 2017 ATA cutoff values. Experience at a maternity hospital in a densely populated area in Mexico City
- Expression pattern and clinical significance of microRNA-let-7a and IFN-gamma in placental tissue of patients with preeclampsia with severe features
- Original Articles – Fetus
- Management of neonates with 35 weeks of gestational age or more with infectious risk factors at birth: opportunities for improvement
