TOPLINE

Women undergoing cesarean delivery who received dexamethasone or ondansetron as first-line antiemetic prophylaxis required a similar number of medications to treat nausea and vomiting, pain, and pruritus during the first 24 hours after delivery.

METHODOLOGY

• Researchers conducted a prospective randomized controlled trial to compare dexamethasone 8 mg with ondansetron 4 mg administered intravenously after induction of spinal anesthesia in women undergoing cesarean delivery.
• A total of 95 women with singleton pregnancies at term aged 18-45 years with American Society of Anesthesiologists physical status II were included in the analysis.
• All participants received neuraxial anesthesia with 1.5 mL hyperbaric bupivacaine 0.75%, 25 µg fentanyl, and 150 µg morphine; they were then randomly assigned to receive either dexamethasone or ondansetron, followed by standardized enhanced recovery after cesarean pathway care.
• The primary outcome was the total number of medications administered for the treatment of nausea and vomiting, pain, or pruritus during the first 24 hours following cesarean delivery. This sum accounted for medications given during the surgery or in the post-anesthesia care unit.
• Secondary outcomes were rates of intraoperative nausea and vomiting, pain scores, visual analog scale scores for pain and pruritus, Obstetric Quality of Recovery scores following the Cesarean Delivery Questionnaire, and use of medications for each adverse effect.

TAKEAWAY

• The mean number of postoperative medications per patient per 24 hours was 0.40 in the dexamethasone group and 0.23 in the ondansetron group (P = .337), with no significant difference observed between the two groups.
• Supplemental opioids for pain control were required in 10.6% of patients in the dexamethasone group and 6.25% of those in the ondansetron group (P = .486).
• Medications for postoperative nausea and vomiting were administered to 21.3% of patients in the dexamethasone group and 16.7% of those in the ondansetron group (P = .609).
• No statistically significant differences were observed between the two groups in terms of scores for pain or postoperative nausea and vomiting, nausea, and pruritus measured at multiple timepoints over 24 hours.

IN PRACTICE

"[W]omen who received either dexamethasone or ondansetron as a first-line agent for the prophylaxis of PONV [postoperative nausea and vomiting] after cesarean delivery at an institution with an established ERAC [enhanced recovery after cesarean] pathway received a statistically similar number of medications for side effects in the first 24 hours. We also found no difference in pain despite prior research showing improvement with dexamethasone, which may be due to the low rate of breakthrough postoperative pain in our study," the researchers wrote.

SOURCE

The study was led by Amnon A. Berger, MD, of the Department of Anesthesiology, Critical Care and Pain Medicine at Beth Israel Deaconess Medical Center in Boston. It was published online on September 10, 2026, in Anesthesia & Analgesia.

LIMITATIONS

The sample size may have been insufficient to detect differences given the low number of medications received by patients. The study did not include groups taking placebo or combination therapy. The researchers did not distinguish between nausea and vomiting; hence, some women may have had one condition without experiencing the other.

DISCLOSURES

The study did not receive any specific funding. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.