Dexamethasone for the Prevention of Post-operative Nausea and Vomiting in Patients Undergoing Cesarean Sections
Dexamethasone for the Prevention of Post-operative Nausea and Vomiting in Patients Undergoing Cesarean Sections
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.
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.
Inclusion Criteria:

 -  Women aged 18-46 presenting for scheduled primary or repeat cesarean sections and have
 consented to study

 Exclusion Criteria:

 -  allergy to dexamethasone or morphine

 -  history of gastrointestinal disease

 -  history of severe nausea during pregnancy (hyperemesis gravidarum)

 -  use of anti-emetic in the past 24 hours

 -  history of gestational diabetes or diabetes mellitus

 -  history of hypertension prior to or during pregnancy

 -  presence of non-viable fetus