Comparative Study on Efficacy of Intrathecal Injection Midazolam (2 mg) Versus Injection Metoclopramide IV in Prevention or Reduction of Nausea and Vomiting in Women during Caesarean Delivery under Spinal Anaesthesia

Background: Nausea and vomiting after spinal anaesthesia in caesarean are frequent causing distress to the patient and surgeon. To diminish the incidence various pharmacological agents were used with their limitations. This study compares intrathecal midazolam with intravenous metoclopramide for prevention of nausea and vomiting during surgery and in the early postoperative period after caesarean delivery performed with spinal anaesthesia.

Materials and Methods: In a randomized single blind manner, 100 women (ASA Grade I and II) undergoing elective caesarean delivery were enrolled for the study with 0.5% hyperbaric bupivacaine 2 ml (10 mg) spinal anaesthesia were randomly allocated in to two groups. Group I received intravenous metoclopramide 10 mg (n = 50 in each group). Group II received intrathecal midazolam preservative free 2 mg (n = 50). Emetic episodes were recorded during anaesthesia and in the initial period after caesarean delivery (0 – 6 hrs) and compared between two groups by using Chi – square test. P value of <0.05 was taken to be significant.

Results: The incidence of patients who were emesis – free in the intraoperative and postoperative period was 39 (78%) with intravenous metoclopramide and 49 (98%) with intrathecal midazolam, respectively (p< 0.001). No clinically important adverse events were observed in either group.

Conclusion: We conclude that use of intrathecal midazolam (2 mg) is more effective than intravenous metoclopramide (10 mg) for preventing nausea and vomiting in women undergoing caesarean delivery under spinal anaesthesia with bupivacaine (0.5%) hyperbaric.