A COMPARATIVE STUDY OF GLYCOPYRROLATE AND DEXAMETHASONE IN THE CONTROL OF PONV AFTER INTRATHECAL FENTANYL AND BUPIVACAINE FOR CAESAREAN SECTION.

Abstract

SUMMARY

BACKGROUND

Postoperative nausea and vomiting (PONV) is an undesirable outcome that parturients who undergo caesarean section experience. Complications of PONV range from discomfort, dehydration, electrolyte imbalance to pulmonary aspiration of gastric contents. Different drugs have been employed as prophylaxis against PONV with varying degrees of success and outcome.

AIM

The aim of this study was to compare the efficacies of IV glycopyrrolate and IV dexamethasone as effective prophyaxis against PONV in women undergoing caesarean section after intrathecal fentanyl and bupivacaine.

PATIENTS AND METHODS

This is a prospective, randomized, double blind placebo controlled study of seventy six (76) ASA II patients aged 18-40 years who underwent elective caesarean section under spinal anaesthesia. Patients were randomly allocated to three groups, group G (glycopyrrolate): n=26, group D (dexamethasone): n=25 and group C (control; normal saline): n=25. Data collection was with the aid of a proforma which included the biophysical profile, ASA physical status, Mallampati scores, patient’s haemodynamics, Belville scoring scale for PONV, Likert scale was used for patient satisfaction and side effects were also documented.

The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 17 and presented in tables and figures.

 

RESULTS

The demographic characteristics and mallampati scores of patients in all 3 groups were similar. Patients in group G had higher mean heart rates compared to groups D and C and this was statistically significant (P=0.046). However, patients in group D recorded the highest mean arterial blood pressure (P=0.028). The results showed that the incidence of PONV in group D was 13.3%, in group G 33.3% and in group C 53.4%. The results showed that the use of 8mg dexamethasone was significantly associated with a lower incidence of PONV (P= 0.048, OR= 0.185, 95% C.I for OR= 0.035 – 0.983). Patients who received IV 8mg dexamethasone were less likely associated with an incidence of PONV. However, the use of IV 0.2mg glycopyrrolate showed a relatively higher incidence of PONV.

All patients expressed satisfaction in the care they received as assessed using the likert scale and only patients who received IV glycopyrrolate experienced side effects in the form of dryness of the mouth. There were no side effects reported in patients who received IV dexamethasone.

CONCLUSION

The study demonstrated the efficacy of 8mg intravenous dexamethasone over 0.2mg intravenous glycopyrrolate in controlling PONV after intrathecal fentanyl and bupivacaine for caesarean section.