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

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 mu g 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 mu g or midazolam 2 mg, both reduce the incidence and severity of nausea-vomiting when administered with bupivacaine for cesarean section.