The optimum management of nausea and vomiting during and after cesarean delivery

Best Pract Res Clin Anaesthesiol. 2020 Dec;34(4):735-747. doi: 10.1016/j.bpa.2020.04.012. Epub 2020 Apr 23.

Abstract

Intraoperative and postoperative nausea and vomiting (IONV and PONV) afflict up to 80% of parturients undergoing cesarean delivery with neuraxial anesthesia. Preventing nausea and emesis is a top priority for women undergoing cesarean delivery and is included in the quality of recovery measures and enhanced recovery after cesarean delivery protocols. The majority of known perioperative emetic triggers can be avoided or mitigated by optimizing anesthetic and surgical management. IONV may arise from spinal anesthesia-induced hypotension, intraoperative pain, and medications such as uterotonics and antibiotics. Furthermore, uterine exteriorization and peritoneal irrigation increase IONV risk. Conversely, preventing PONV mainly focuses on optimizing analgesia through an opioid-sparing, multimodal strategy. In addition, combination prophylactic antiemetic therapy should be instituted in this high-risk population to further reduce the risk of IONV and PONV.

Keywords: cesarean delivery; intrathecal opioids; nausea; neuraxial anesthesia; vomiting.

Publication types

  • Review

MeSH terms

  • Anesthesia, Obstetrical / adverse effects
  • Anesthesia, Obstetrical / methods*
  • Antiemetics / administration & dosage*
  • Cesarean Section / adverse effects
  • Cesarean Section / methods*
  • Dopamine Antagonists / administration & dosage
  • Female
  • Humans
  • Injections, Spinal
  • Intraoperative Complications / physiopathology
  • Intraoperative Complications / prevention & control*
  • Postoperative Nausea and Vomiting / physiopathology
  • Postoperative Nausea and Vomiting / prevention & control*
  • Pregnancy
  • Serotonin 5-HT3 Receptor Antagonists / administration & dosage

Substances

  • Antiemetics
  • Dopamine Antagonists
  • Serotonin 5-HT3 Receptor Antagonists