Comparison of Ondansetron and Metoclopramide for Prevention of Nausea and Vomiting in Elective Caesarean Section Under Spinal Anesthesia

Saima Jehan; Fiyyaz Akhter Qureshi

doi:10.54112/bcsrj.v6i5.2308

Authors

Saima Jehan Department of Anesthesia, Hayatabad Medical Complex, Peshawar, Pakistan
Fiyyaz Akhter Qureshi Department of Anesthesia, Hayatabad Medical Complex, Peshawar, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v6i5.2308

Keywords:

Ondansetron, Metoclopramide, Postoperative Nausea and Vomiting, Caesarean Section, Spinal Anesthesia

Abstract

Postoperative nausea and vomiting (PONV) are common complications following cesarean section performed under spinal anesthesia and can negatively affect maternal comfort, recovery, and satisfaction. Antiemetic prophylaxis is routinely administered to reduce the incidence of PONV. Both ondansetron and metoclopramide are widely used; however, comparative evidence regarding their effectiveness in obstetric patients remains limited. Objective: To compare the efficacy of ondansetron and metoclopramide in preventing postoperative nausea and vomiting in patients undergoing elective cesarean section under spinal anesthesia. Methods: This comparative study was conducted in the Department of Anesthesia at Hayatabad Medical Complex from August 9, 2024, to February 9, 2025. A total of 268 patients undergoing elective cesarean section under spinal anesthesia were enrolled and non-randomly allocated into two equal groups. Group A received intravenous ondansetron at a dose of 0.15 mg/kg, while Group B received intravenous metoclopramide at a dose of 0.25 mg/kg. The incidence of postoperative nausea and vomiting was assessed during the first 60 minutes following administration of spinal anesthesia. Data were analyzed using SPSS version 27. Comparisons between groups were performed using the chi-square test, with a p-value ≤0.05 considered statistically significant. Results: A total of 268 patients were included, with 134 patients in each group. Postoperative nausea occurred in 19 (14.2%) patients receiving ondansetron compared with 33 (24.6%) patients receiving metoclopramide (p = 0.03). Similarly, postoperative vomiting was observed in 16 (11.9%) patients in the ondansetron group and 30 (22.4%) patients in the metoclopramide group (p = 0.02). Subgroup analysis demonstrated that the antiemetic benefit of ondansetron was particularly pronounced among younger patients aged 18–24 years. Conclusion: Ondansetron was significantly more effective than metoclopramide in reducing the incidence of postoperative nausea and vomiting following elective cesarean section under spinal anesthesia. These findings support the preferential use of ondansetron as a prophylactic antiemetic in obstetric patients undergoing cesarean delivery.

Downloads

Download data is not yet available.

191

References

1. Amirshahi M, Behnamfar N, Badakhsh M, Rafiemanesh H, Keikhaie KR, Sheyback M, et al. Prevalence of postoperative nausea and vomiting: a systematic review and meta-analysis. Saudi J Anaesth. 2020;14(1):48-56. DOI: https://doi.org/10.4103/sja.SJA_401_19

2. Rajan N, Joshi GP. Management of postoperative nausea and vomiting in adults: current controversies. Curr Opin Anaesthesiol. 2021;34(6):695-702. DOI: https://doi.org/10.1097/ACO.0000000000001063

3. Qian Y, Zhu JK, Hou BL, Sun YE, Gu XP, Ma ZL. Risk factors of postoperative nausea and vomiting following ambulatory surgery: a retrospective case-control study. Heliyon. 2022;8(12):e12430. DOI: https://doi.org/10.1016/j.heliyon.2022.e12430

4. Darvall JN, Handscombe M, Maat B, So K, Suganthirakumar A, Leslie K. Interpretation of the four risk factors for postoperative nausea and vomiting in the Apfel simplified risk score: an analysis of published studies. Can J Anaesth. 2021;68(7):1057-1063. DOI: https://doi.org/10.1007/s12630-021-01974-8

5. Emadi SA, Gholipour Baradari A, Khademloo M, Abotorabi M, Hassanzadeh Kiabi F. Evaluating patients' choice of general and spinal anesthesia for elective cesarean section and associated factors: a descriptive study. Ann Med Surg (Lond). 2023;85(1):6-12. DOI: https://doi.org/10.1097/MS9.0000000000000010

6. Yu C, Gu J, Liao Z, Feng S. Prediction of spinal anesthesia-induced hypotension during elective cesarean section: a systematic review of prospective observational studies. Int J Obstet Anesth. 2021;47:103175. DOI: https://doi.org/10.1016/j.ijoa.2021.103175

7. Bjornestad EE, Haney M. An obstetric anesthetist: a key to successful conversion of epidural analgesia to surgical anesthesia for cesarean delivery? Acta Anaesthesiol Scand. 2020;64(2):142-144. DOI: https://doi.org/10.1111/aas.13493

8. Kothari A, Shah P, Patel U. Preoperative ondansetron versus metoclopramide for prevention of nausea and vomiting in elective lower segment caesarean section under spinal anaesthesia. Int J Sci Res. 2021;10(7):24-25. DOI: https://doi.org/10.36106/ijsr/5229143

9. Ebrahimian M, Mirhashemi SH, Oshidari B, Zamani A, Shadidi-Asil R, Kialashaki M, et al. Effects of ondansetron, metoclopramide, and granisetron on perioperative nausea and vomiting in patients undergoing bariatric surgery: a randomized clinical trial. Surg Endosc. 2023;37(6):4495-4504. DOI: https://doi.org/10.1007/s00464-023-09939-2

10. Liu R, Bi R, Zhang J, Li X, Tian B, Yan W. Promethazine combined with metoclopramide for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic colorectal cancer surgery: a randomized controlled trial. Drug Des Devel Ther. 2025;19:9029-9039. DOI: https://doi.org/10.2147/DDDT.S526724

11. Singha D, Thakur A, Nazar MF, Singh J, Bhandari S, Sood P. Comparative study of palonosetron with metoclopramide and ondansetron in prevention of PONV in laparoscopic cholecystectomy: a randomized controlled trial. Int J Med Anesth. 2021;4(3):122-127. DOI: https://doi.org/10.33545/26643766.2021.v4.i3b.292

12. Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2020;131(2):411-448. DOI: https://doi.org/10.1213/ANE.0000000000004833

13. Gress K, Urits I, Viswanath O, Urman RD. Clinical and economic burden of postoperative nausea and vomiting: analysis of existing cost data. Best Pract Res Clin Anaesthesiol. 2020;34(4):681-686. DOI: https://doi.org/10.1016/j.bpa.2020.07.003

14. Vasantha Kumar J, Shivanand PT, Ravi R. Pre-operative ondansetron vs metoclopramide for prevention of post-operative nausea and vomiting in elective lower-segment caesarean section under spinal anaesthesia. Int J Res Med Sci. 2014;2(1):175-179. DOI: https://doi.org/10.5455/2320-6012.ijrms20140234

15. Hendre A, Bhale R. Comparison of ondansetron and metoclopramide for prevention of nausea and vomiting in elective LSCS under spinal anesthesia. Int J Pharm Clin Res [Internet]. 2021 [cited 2025 Oct 27];13(5):208-214. Available from: https://impactfactor.org/PDF/IJPCR/13/IJPCR,Vol13,Issue5,Article31.pdf

16. Qadeer MK, Wadood R, Hameed J. Comparison of oral ondansetron and metoclopramide in reducing postoperative nausea and vomiting in gynecological laparoscopic procedures. Indus J Biosci Res. 2025;3(4):646-651. DOI: https://doi.org/10.70749/ijbr.v3i4.998

17. Riaz MM, Shah SQA, Khan TA, Tariq W, Husnain F, Bhatty QA. Comparison of ondansetron and metoclopramide on reducing nausea and vomiting after laparoscopic cholecystectomy in females. Pak Armed Forces Med J. 2024;74(4):1165-1168.

18. Shahid N, Jamshed S, Khan F, Rasheed AM, Ali A, Anwar A. Comparing the effectiveness of ondansetron and dexamethasone on nausea/vomiting in cesarean section under spinal anesthesia. Pak J Med Dent. 2022;11(2):9-14.

19. Dutta D, Mishra N, Ghosh S. A comparative study between ondansetron, dexamethasone, and propofol for prevention of intraoperative nausea and vomiting in patients undergoing cesarean section under spinal anesthesia. J Med Sci Clin Res. 2019;7(7):327-333. DOI: https://doi.org/10.18535/jmscr/v7i7.61

20. Hou XM, Chen YJ, Lai L, Liu K, Shen QH. Ondansetron reduces the incidence of hypotension after spinal anesthesia: a systematic review and meta-analysis. Pharmaceuticals (Basel). 2022;15(12):1588. DOI: https://doi.org/10.3390/ph15121588

21. Bhiwal AK, Chauhan K, Choudhary S, Bhatt HA, Gupta S. Intravenous ondansetron to prevent hypotension during cesarean section under spinal anaesthesia. J Obstet Anaesth Crit Care. 2021;11(1):15-19. DOI: https://doi.org/10.4103/joacc.JOACC_61_20

22. Hailu S, Mekonen S, Shiferaw A. Prevention and management of postoperative nausea and vomiting after cesarean section: a systematic literature review. Ann Med Surg (Lond). 2022;75:103433. DOI: https://doi.org/10.1016/j.amsu.2022.103433