Comparison of intrathecal fentanyl and midazolam for prevention of nausea-vomiting during cesarean section under spinal anesthesia

Abstract

Aims and Objectives: Nausea and vomiting remain as “the big little problem” in cesarean section under
spinal anesthesia. Incidence of nausea-vomiting during and immediately after surgery in spinal anesthesia
is high. It is physically as well as mentally distressing to the patient and disturbing to the surgeon and
the anesthesiologist. Purpose of this study was to compare the clinical efficacy of intrathecal fentanyl and
midazolam for prevention of nausea-vomiting in parturients undergoing cesarean section under spinal
anesthesia.
Methodology: This prospective randomized double blind study was conducted in 90 women aged
between 18-31 years (ASA physical status I) scheduled to undergo elective cesarean section under spinal
anesthesia. Subjects were randomly divided into three equal groups. Group A received 0.5 ml normal
saline, Group B received 2 mg midazolam and Group C received 12.5 μg fentanyl with 2 ml of hyperbaric
bupivacaine 0.5% intrathecally. Nausea-vomiting was assessed according to Belville’s score. The statistical
analysis of data was done by using statistical package for social science (SPSS) evaluation version 20.
Results were expressed as mean, standard deviation, and range values. Frequencies expressed as number
and percentage. ANOVA was used for multiple group comparisons, and categorical data were analyzed
by Chi-square test.
Results: 24 subjects out of 30 in the placebo group developed intraoperative and early postoperative
nausea-vomiting compared to 11 in midazolam group and 8 in fentanyl group. Incidence of intraoperative
and early postoperative nausea-vomiting was 79.5% with placebo, 36.6% with midazolam and 26.6% with
fentanyl.
Conclusion: Intrathecal fentanyl 12.5 μg or midazolam 2 mg, both reduce the incidence and severity of
nausea-vomiting when administered with bupivacaine for cesarean section.