After caesarean, dexamethasone was no better than ondansetron as first-line antiemetic

Design

Randomised double-blind trial

Population

95 women having caesarean delivery under spinal with intrathecal morphine

Primary outcome

Medications for nausea, pain or pruritus in 24 h

Effect

Dexamethasone 0.40 vs ondansetron 0.23 per patient; P = 0.34

A double-blind trial randomised 100 women having caesarean delivery under spinal anaesthesia with 150 µg intrathecal morphine and an enhanced recovery protocol to dexamethasone 8 mg or ondansetron 4 mg; 95 completed.

The number of medications given for nausea, pain or pruritus in 24 hours did not differ (0.40 vs 0.23 per patient; P = 0.34). Pain, nausea and pruritus scores were similar. The expected analgesic benefit of dexamethasone did not appear, perhaps because pain was already well controlled.

The trial was small and underpowered for modest differences. It supports continuing to use either agent, and does not justify replacing ondansetron with dexamethasone.

• Either agent is reasonable first-line prophylaxis after caesarean with intrathecal morphine.
• Consider combining agents for women at high risk of nausea.
• Keep regular non-opioid analgesia in place — it may matter more than steroid.

Why it matters

It questions the claim that dexamethasone brings an extra analgesic benefit when analgesia is already good.

The statistics, in plain English

A P value of 0.34 means the difference was well within chance. With 95 women, only large differences could have been detected.

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