Research Article

Dose-Dependent Antiemetic Effect of Intravenous Dexamethasone Compared with Paracetamol for Prevention of Postoperative Nausea and Vomiting after Cesarean Delivery under Spinal Anesthesia: A Triple-Blind Randomized Controlled Trial

Abstract

Background: Postoperative nausea and vomiting (PONV) are common after cesarean delivery under spinal anesthesia and may impair maternal recovery and early postoperative comfort. Dexamethasone is an established antiemetic, but the optimal prophylactic dose in obstetric patients remains unclear. This study evaluated the dose–response effect of intravenous dexamethasone compared with paracetamol and placebo for the prevention of PONV after cesarean delivery.
Methods: In this randomized triple-blind clinical trial, 239 parturients undergoing cesarean delivery under spinal anesthesia were allocated to five groups: placebo, paracetamol 1 g, dexamethasone 2 mg, dexamethasone 4 mg, and dexamethasone 6 mg. The primary outcome was the incidence of PONV during the first six postoperative hours. Secondary outcomes included PONV severity, treatment effect expressed as odds ratios, and dose–response trend across dexamethasone groups.
Results: The incidence of PONV was highest in the placebo group at 70%. PONV occurred in 55% of patients receiving paracetamol, 40% receiving dexamethasone 2 mg, 25% receiving dexamethasone 4 mg, and 12% receiving dexamethasone 6 mg. Compared with placebo, paracetamol reduced the odds of PONV, although the effect was smaller than that observed with dexamethasone. Dexamethasone showed a significant dose-dependent reduction in both incidence and severity of PONV. The strongest effect was observed with dexamethasone 6 mg, which was associated with the lowest PONV incidence and no cases of severe vomiting.
Conclusion: Intravenous dexamethasone significantly reduced the incidence and severity of PONV after cesarean delivery under spinal anesthesia in a dose-dependent manner. Dexamethasone 4 mg appears to offer an effective balance between antiemetic efficacy and limited steroid exposure, while 6 mg provides the greatest reduction in PONV. Paracetamol showed a smaller antiemetic effect and may be more appropriate as an analgesic adjunct than as a primary antiemetic.

[1] Henzi I, Walder B, Tramèr MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg. 2000; 90(1):186-94.
[2] Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth. 2013;110(2):191-200.
[3] Jelting Y, Klein C, Harlander T, Eberhart L, Roewer N, Kranke P. Preventing nausea and vomiting in women undergoing regional anesthesia for cesarean section: challenges and solutions. Local Reg Anesth. 2017; 10:83-90.
[4] Dyer RA, van Dyk D, Dresner A. The use of uterotonic drugs during caesarean section. Int J Obstet Anesth. 2010; 19(3):313-9.
[5] Abola R, Romeiser J, Grewal S, Rizwan S, Adsumelli R, Steinberg E, et al. Association of postoperative nausea/vomiting and pain with breastfeeding success. Perioper Med (Lond). 2017; 6:18.
[6] Allen TK, Jones CA, Habib AS. Dexamethasone for the prophylaxis of postoperative nausea and vomiting associated with neuraxial morphine administration: a systematic review and meta-analysis. Anesth Analg. 2012;114(4):813-822.
[7] Sane S, Valizadeh Hasanlui MA, Abbasivash R, Mahoori A, Hashemi ST, Rafiei F. Comparing the effect of intravenous dexamethasone, intravenous ondansetron, and their combination on nausea and vomiting in cesarean section with spinal anesthesia. Adv Biomed Res. 2015;4:230.
[8] Demirhan A, Tekelioglu UY, Akkaya A, Ozlu T, Yildiz I, Bayir H, et al. Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia. Afr Health Sci. 2013;13(2):475-482.
[9] Holte K, Kehlet H. Perioperative single-dose glucocorticoid administration: pathophysiologic effects and clinical implications. J Am Coll Surg. 2002;195(5):694-712.
[10] 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.
[11] Waldron NH, Jones CA, Gan TJ, Allen TK, Habib AS. Impact of perioperative dexamethasone on postoperative analgesia and side-effects: systematic review and meta-analysis. Br J Anaesth. 2013;110(2):191-200.
[12] Atashkhoyi S, Rasouli S, Fardiazar Z, Ghojazadeh M, Hatami Marandi P. Preventive analgesia with intravenous paracetamol for post-cesarean section pain control. Int J Womens Health Reprod Sci. 2014;2(3):193-196.
[13] Sultan P, Halpern SH, Pushpanathan E, Patel S, Carvalho B. The effect of intrathecal morphine dose on outcomes after elective cesarean delivery: a meta-analysis. Anesth Analg. 2016;123(1):154-164.
[14] 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):411-48. Erratum in: Anesth Analg. 2020; 131(5):e241.
[15] Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999; 91(3):693-700.
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Keywords
Cesarean section dexamethasone paracetamol postoperative nausea and vomiting spinal anesthesia dose-response relationship.
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1.
Masaeli M, Mirzaee Tabar K, Abshenas Jami M. Dose-Dependent Antiemetic Effect of Intravenous Dexamethasone Compared with Paracetamol for Prevention of Postoperative Nausea and Vomiting after Cesarean Delivery under Spinal Anesthesia: A Triple-Blind Randomized Controlled Trial. Arch Anesth & Crit Care. 2026;.