Intrathecal midazolam for prevention of nausea and vomiting during and after cesarean section under spinal anaesthesia.

Relevant incidences of nausea-vomiting during and immediately after cesarean section in spinal anesthesia are found to be high. Effectiveness of intrathecal midazolam (2 mg) as an adjuvant to bupivacaine on the incidence and severity of intraoperative and immediate postoperative nausea and vomiting was investigated in the present study.

A randomized, controlled, double-blind study was conducted in 120 healthy women (ASA Physical status I and II) scheduled for elective cesarean section under spinal anesthesia. Parturients were randomly divided into two equal groups of 60 each. Group M(study group)-Patients received 10 mg (2.0ml) of 0.5% hyperbaric bupivacaine combined with 2 mg (0.4 ml) midazolam intrathecally and Group C (control group)-10 mg (2.0ml) of 0.5% hyperbaric bupivacaine combined with 0.4 ml normal saline intrathecally. Assessment of the patients were done for incidence of nausea-vomiting, hemodynamic effects and occurrence of adverse effects during cesarean section and during first 6 hours after the operation.

Incidence of emetic symptoms in Group M were significantly lower than Group C (15% vs 63.34%, p < 0.05). There were no clinically serious adverse events observed in any of the groups. All neonates had APGAR scores more than 8 at one and five minutes.

Intrathecal midazolam as an adjuvant to Bupivacaine is associated with lower incidence of nausea and vomiting with no neonatal adverse effects.