Dexamethasone for the Prevention of Post-operative Nausea and Vomiting in Patients Undergoing Cesarean Sections
Condition: Postoperative Nausea and Vomiting
MeSH terms: Nausea; Vomiting; Postoperative Nausea and Vomiting
Study type: Interventional
Phase: Phase 4

Summary: 
      Patients who present for scheduled (non-emergent) cesarean section will be given either
      intravenous dexamethasone or placebo prior to receiving a duramorph containing spinal
      anesthetic. The investigators will then compare the incidence of nausea and vomiting and the
      use of rescue anti-nausea medications in both groups. Our hypothesis is that patients
      receiving dexamethasone prior to duramorph containing spinal anesthesia for cesarean section
      will have a significantly lower incidence and severity of PONV at 0, 1, 3, 6, and 24 hours
      following surgery.
    

Detailed description: 
      Women having cesarean sections commonly experience post-operative nausea and vomiting (PONV).
      This can be partly attributed to the long acting morphine (duramorph) given in the anesthetic
      (either through the epidural or in the spinal anesthetic). Intravenous dexamethasone is a
      widely used steroid medication with a well-established safety profile which is the standard
      of care for the prevention of PONV for general anesthesia in both adult and pediatric
      surgical patients. Many studies have shown that when intravenous dexamethasone is
      administered before duramorph in the epidural, the incidence of nausea and vomiting following
      cesarean section is significantly reduced. However, when patients receive intravenous
      dexamethasone after duramorph in a spinal anesthetic, it does not reduce the incidence of
      nausea and vomiting. There are not any published studies where dexamethasone was administered
      before a spinal anesthetic. The investigators believe that if dexamethasone is given
      intravenously before duramorph in a spinal anesthetic it may reduce the incidence of nausea
      and vomiting. Patients who present for scheduled (non-emergent) cesarean section will be
      given either intravenous dexamethasone or placebo prior to receiving a duramorph containing
      spinal anesthetic. The investigators will then compare the incidence of nausea and vomiting
      and the use of rescue anti-nausea medications in both groups. Our hypothesis is that patients
      receiving dexamethasone prior to duramorph containing spinal anesthesia for cesarean section
      will have a significantly lower incidence and severity of PONV at 0, 1, 3, 6, and 24 hours
      following surgery.
    

Intervention name(s): Dexamethasone; Placebo
Intervention type(s): Drug; Drug
Intervention description(s): 8mg IV dexamethesone given; Subjects randomized to placebo receive 50cc normal saline
Other intervention name(s): Decadron; 50 ml 0.9% saline
Intervention MeSH terms: Dexamethasone
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: cesarean section; nausea; vomiting; dexamethasone; postoperative nausea and vomiting; antiemetics