Hyoscine Butyl-bromide Versus Ondansetron for Nausea and Vomiting During Cesarean Section Under Spinal Anesthesia
Condition: Vomiting
MeSH terms: Vomiting
Study type: Interventional
Phase: Phase 4

Summary: 
      overall incidence of intraoperative nausea and vomiting(IONV) during regional anesthesia for
      cesarean section is extremely variable, up to 80 percent , depending on the anesthetic
      technique used (spinal, epidural or combined spinal-epidural) and on the preventive and
      therapeutic measures taken.1 Spinal anesthesia for CS is safe and effective; it is currently
      the anesthetic technique of choice for elective Cesarean delivery (CD). However, maternal
      hypotension associated with spinal anesthesia is one of the primary causes of intraoperative
      nausea and/or vomiting (IONV); this symptom is thought to be caused by cerebral and gut
      hypoperfusion that stimulate the vomiting centre in the brainstem and cause serotonin
      release, respectively.2, 3 While bolus dosing of phenylephrine effectively treats maternal
      hypotension, it does not prevent intraoperative maternal nausea, which may be associated with
      established hypotension, and this may adversely affect patient satisfaction.4, 5 However, the
      unopposed vagal activity that occurs with sympathetic block might be another cause of
      intraoperative nausea and vomiting during spinal anesthesia.6

      Both scopolamine and atropine are tertiary amines, which cross the blood-brain barrier with
      central side effects, such as confusion, sedation, or paradoxical excitation. However,
      Hyoscine butyl bromide (HBB) has a quaternary ammonium structure that does not cross through
      the blood-brain barrier and also with lower placental transfer than atropine, making it more
      suitable for use in pregnancy 7, 8.

      Hyoscine Butyl-bromide, also known as scopolamine butyl-bromide and sold under the brand name
      Buscopan.9 Despite being a quaternary ammonium compound, HBB is still capable of targeting
      the chemoreceptor trigger zone due to the lack of a well-developed blood-brain-barrier in the
      medulla oblongata, which potentiates the antiemetic effects that it produces through local
      action on the smooth muscle of the gastrointestinal tract.10

      So, the aim of the current study is to examine the effect of prophylactic use of HBB and
      Ondansetron to decrease the incidence of intraoperative bradycardia and thus intraoperative
      nausea and vomiting in parturients undergoing CD under spinal anaesthesia.
    


Intervention name(s): Hyoscine N Butylbromide; Ondansetron; Saline
Intervention type(s): Drug; Drug; Drug
Intervention description(s): Patients will receive IV hyoscine butyl-bromide 20 mg in 2 ml, just before spinal anaesthesia.; Patients received IV ondansetron 4 mg in 2 ml, just before spinal anaesthesia.; Patients received 2 ml of IV normal saline as a placebo just before spinal anaesthesia.
Intervention MeSH terms: Scopolamine; Ondansetron; Butylscopolammonium Bromide
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Prevention