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Metoclopramide for nausea and vomiting prophylaxis during and after Caesarean delivery: a systematic review and meta-analysis - 7/3/2012

Br J Anaesth 2012; 108: 374-83


These authors carried out a meta-analysis to assess the efficacy of metoclopramide for prophylaxis against intra- and postoperative nausea and vomiting (IONV and PONV) in parturients undergoing Caesarean delivery CD under neuraxial anaesthesia.


The authors performed a literature search of MEDLINE (1966–2011), Cochrane Central Register of Controlled Trials, EMBASE (1947–2011), Google scholar and CINAHL for randomised controlled trials which compared metoclopramide with placebo in women having CD under neuraxial anaesthesia. Eleven studies with 702 patients were included in the analysis.


Administration of metoclopramide (10 mg) resulted in a significant reduction in the incidence of ION and IOV when given before block placement (relative risk [RR] 0.27 [95% confidence interval {CI} 0.16 to 0.45] and 0.14 [95% CI 0.03 to 0.56], respectively) or after delivery (RR 0.38 [95% CI 0.20 to 0.75] and 0.34 [95% CI 0.18 to 0.66], respectively). The incidence of early (0–3 or 0–4-hour) PON and POV (RR 0.47 [95% CI 0.26 to 0.87] and 0.45 [95% CI 0.21 to 0.93], respectively) and overall (0–24 or 3–24-hour) PON (RR 0.69; 95% CI 0.52 to 0.92) were also reduced with metoclopramide. Extrapyramidal side effects were not reported in any patient.


The authors conclude that metoclopramide is effective and safe for IONV and PONV prophylaxis in this patient population. However, they warn that, given the quality of the studies and the infrequent use of neuraxial opioids, these results should be interpreted with caution in current practice, and that further studies are needed to confirm those findings.

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