Pre-operative ondansetron vs. metoclopramide for prevention of post-operative nausea and vomiting in elective lower-segment caesarean section under spinal anaesthesia

Vasantha Kumar J, Shivanand P. T., Ravi R


Background: The problem of nausea and vomiting is a very old but a less thought of problem. Nausea and vomiting are the most common distressing symptom in the postoperative period. Antiemetic drugs play an important role in therapy of post-operative nausea and vomiting (PONV). Though many drugs have been tried as prophylaxis and treatment of PONV, no drug has been proved significantly effective and hence, the present study was undertaken to compare the efficacy and safety of IV metoclopramide and IV Ondansetron as prophylaxis for postoperative nausea and vomiting in lower-segment caesarean section (LSCS) under spinal anaesthesia.

Methods: After institutional approval and informed consent 100 ASA I & II patients undergoing non emergent LSCS taken for study. The patients were divided randomly into 2 groups of 50 each. Group I received IV metoclopramide 10mg and Group II received IV. Ondansetron 4mg. Anaesthetic management was standardized. The incidence of vomiting and retching as number of episodes was studied. Nausea was graded depending on the severity and data derived.

Results: The mean age, weight and duration of surgery was not significantly different when compared group-1 parturiants with group-2. The mean episodes of emesis, nausea and retching at different postoperative duration were significantly decreased (p<0.05) in Ondansetron group when compared to metoclopramide group as postoperative time progresses.

Conclusions: Injection ondansetron 4mg provided decrease in the incidence of PONV than metoclopramide as the side effects with these drugs were minimal.



PONV, Antiemetic drugs, Metoclopramide, Ondansetron

Full Text:



Rowbotham DJ. "Current management of postoperative nausea and vomiting". Br J Anaesth. 1992;69:60S-2S.

Patel RI, Hanrallah RS. "Anaesthetic complications following pediatric ambulatory surgery". Anaesthesiology, 1988;69:1009-12.

Bunce KT, Tyers ME. "The role of 5-HT in postoperative nausea and vomiting". Br J Anaesth. 1992;69:60S-2S.

Bodner M, White PF. "Antiemetic efficacy of ondansetron after outpatient laparoscopy". Anesth Analg. 1991;73:250-4.

Watcha MF, White PF. "Postoperative nausea and vomiting". Anaesthesiology. 1992;77:162-84.

Craigo P A. Paul A. Gastrointestinal physiology: “Aspiration of gastric contents; postoperative nausea and vomiting". Chapter 21. Collins VI: “Physiology and pharmacological bases of anaesthesia". 1st ed. UK: Baltimore Williams and Wilkins; 1996:361-394.

Leeser J, Lip H. "Prevention of postoperative nausea and vomiting using ondansetron, a new selective, 5-HT3 receptor antagonist". Anesth Analg. 1991;72:751-5.

Alon E, Himmelseher S. "Ondansetron in the treatment of postoperative vomiting: A randomized double-blind comparison with droperidol and metoclopramide". Anesth Analg. 1992;75:561-5.

Kortilla K. "The study of postoperative nausea and vomiting". Br J Anaesth. 1992;69:205-35.

Rabey PO, Smith O. "Anaesthetic factors contributing to postoperative nausea and vomiting". Br J Anaesth. 1992;69:40S-5S.

Russell D, Kenny ONC. "5-HT3 antagonists in postoperative nausea and vomiting". Br J Anaesth. 1992;69:63S-8S.

Pan PH, Moore CH. Comparing the efficacy of prophylactic metoclactic metoclopramide On placebo in cesarean section patients giving epidural Anesthesia. J. Clin Aneath. 2001:13(6):430-5.

Furst SR, Rodarte A. "Prophylactic antiemetic treatment with ondansetron in children undergoing tonsillectomy" Anaesthesiology. 1994;81:799-803.

Burtles Peerr B. Postoperative vomiting: Some factors affecting its incidence. Br. J Anaesth 1957;29:114-23.

Gan TJ, Collins R, Hetreed M. "Double blind comparison of ondansetron, droperidol and saline in the prevention of postoperative nausea and vomiting". Br J Anaesth. 1994;72:544-7.

Paxton LD, Mackay AC, Mirakhur RK. "Prevention of nausea and vomiting after day care gyaecological laparoscopy". Anaesthesia. 1995;50:403-6.

Dupreyron Jp, Conseiller C, Levarlet M. "The effect of oral ondansetron in the prevention of postoperative nausea and vomiting after major gynaecological surgery performed under general anaesthesia". Anaesthesia. 1993;48:214-8.

Scuderi P, Wetchler B, Fong-Sung Y. "Double-blind, randomized comparison of ondansetron and intraoperative propofol to prevent postoperative nausea and vomiting". Anaesthesiology. 1993;78:15-20.

Koyama S, Kurita S, Nakatani K, Nagata N, Toyoda Y. Preoperative intravenous of droperidol (1.25 mg) reduced postoperative nausea and vomiting after intrathecal morphine administration. Masui 2011 Feb;60(2):173-9.