Use of propofol for prevention of post-delivery nausea during cesarean section: a double-blind, randomized, placebo-controlled trial

Kun Niu, Hui Liu, Ruo-Wen Chen, Qi-Wu Fang, Hui Wen, Su-Mei Guo, John P Williams, Jian-Xiong An, Kun Niu, Hui Liu, Ruo-Wen Chen, Qi-Wu Fang, Hui Wen, Su-Mei Guo, John P Williams, Jian-Xiong An

Abstract

Purpose: Nausea and vomiting are common, undesirable symptoms during cesarean section. We conducted this study to assess the antiemetic properties of propofol for the prevention and immediate treatment of post-delivery nausea and vomiting during cesarean section under combined spinal-epidural anesthesia.

Methods: Eighty women undergoing elective cesarean delivery under combined spinal-epidural anesthesia were randomized to receive either propofol at a plasma concentration of 1000 ng/mL or normal saline immediately after clamping of the umbilical cord. The incidence of post-delivery nausea and vomiting, patients requiring rescue antiemetic, bispectral index, sedation score, and the incidence of hypotension were assessed intraoperatively. Satisfaction and neonatal behavioral neurological assessments were evaluated postoperatively.

Results: The incidence of nausea was significantly lower in the propofol group compared to the placebo group (25% versus 60%, P < 0.001). The incidence of retching and vomiting showed no significant difference between the two groups. Propofol 20 mg as a rescue antiemetic was significantly effective in both the groups. Satisfaction level of patients and obstetricians in the propofol group was higher than in the placebo group. There was no statistical difference in the incidence of hypotension between the two groups both pre- and post-delivery. There was no difference in postoperative neonatal behavioral neurological assessment between groups.

Conclusion: Propofol at a plasma concentration of 1000 ng/mL significantly reduced the incidence of post-delivery nausea compared to placebo, but had no effect on reducing retching or vomiting episodes during cesarean section.

Keywords: Cesarean section; Nausea and vomiting; Post-delivery; Propofol.

Conflict of interest statement

The authors have no conflict of interests.

Figures

Fig. 1
Fig. 1
Participant flowchart according to CONSORT statement
Fig. 2
Fig. 2
The Verbal Rating Score and the number of ondansetron treatment vs time in a linear scale. The values are presented as mean ± SD. a The Verbal Rating Score. There was a significant decrease in Verbal Rating Score (*P < 0.05) at 20 and 30 min after the baby was delivered in the propofol group compared with the placebo group. b The number of patients with ondansetron treatment. There was no difference in the administration of ondansetron treatment between two groups in every period after delivery
Fig. 3
Fig. 3
Bis value and sedation scores vs time in a linear scale. The values are presented as mean ± SD. a The median BIS values in the study groups and individual time intervals. There was a significant decrease in BIS value (*P < 0.05) at 10 and 20 min after the baby was delivered in the propofol group compared with the placebo group. BIS bispectral index. b The mean sedation scores. There was a significant decrease in sedation score (*P < 0.05) at 10 and 20 min after the baby was delivered in the propofol group compared with the placebo group

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