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Intraoperative Nausea-retching-vomiting EpisodesPhase 4NCT04697277

Antibiotic Prophylaxis and Nausea and Vomiting in Cesarean Section Under Regional Anesthesia.

A Phase 4 study testing Antibiotic prophylaxis timing (before skin incision and after cord clamping) for caesarean section in people with Intraoperative Nausea-retching-vomiting Episodes and Nausea Scores Will be Evaluated on the Verbal Analog Scale (VAS), run by Baskent University Ankara Hospital at 1 site in Turkey (Türkiye).

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

The incidence of intraoperative nausea and vomiting in patients who undergo caesarean section (C/S) under regional anesthesia is approximately 30-80%. Hypotension, pain, visceral manipulation, fundal pressure, removal of the uterus during repair, intra-abdominal irrigation, central neural opioids, intravenous oxytocin… Read more about this study

Who is it for?
Ages 18 to 40 years, women only
What is being tested?
Antibiotic prophylaxis timing (before skin incision and after cord clamping) for caesarean section
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
120 participants
Where
1 siteTurkey (Türkiye)
Study dates
20 Aug 2015to 30 May 2021
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 40 years
  • Women only
  • No healthy volunteers
  • Adult

Who may be able to join

  • Pregnant women (≥ 37 gestational weeks) undergoing elective C/S under regional anesthesia

Who cannot join

  • Emergency C/S cases
  • Patients who had nausea before C/S
  • Patients who used antiemetics within 24 hours before C/S
  • Patients who have a history of smoking, postoperative nausea-vomiting, motion sickness, and hyperemesis before C/S
  • Patients with history of diabetes, morbid obesity (Body Mass Index> 40) and gastrointestinal disease
  • Psychiatric disorders
  • Patients who are allergic to the drugs to be used in the study
  • Patients for whom regional anesthesia is contraindicated

Trial locations and contacts

1 site in 1 country.

Turkey (Türkiye)1 site, 1 recruiting
  • Baskent University

    Ankara

    Bahattin Tuncali, +90 232 2411000, tuncali.bahattin@gmail.com

    Recruiting

Other trials in Turkey (Türkiye)

About this study

Official title: The Effect of Antibiotic Prophylaxis Timing on Intraoperative Nausea and Vomiting in Patients Undergoing Cesarean Section Under Regional Anesthesia.

The incidence of intraoperative nausea and vomiting in patients who undergo caesarean section (C/S) under regional anesthesia is approximately 30-80%. Hypotension, pain, visceral manipulation, fundal pressure, removal of the uterus during repair, intra-abdominal irrigation, central neural opioids, intravenous oxytocin and antibiotics are possible risk factors. Oxytocin and prophylactic antibiotics are administered simultaneously during C/S operation, especially after the umbilical cord is clamped. Simultaneous administration of drugs such as oxytocin and prophylactic antibiotics may induce nausea and vomiting after umbilical cord clamping in the patient. In this study, it was aimed to investigate the effect of prophylactic antibiotic administration 30 minutes before the incision and after cord clamping on intraoperative nausea and vomiting in patients undergoing elective C/S under regional anesthesia.

This study was planned to be carried out in Başkent University Zübeyde Hanım Research Center Operating Room with 120 pregnant women (≥ 37 gestational weeks) undergoing elective C/S under regional anesthesia in a prospective, randomized, double-blind manner.

Read more

Group 1 (Prophylactic antibiotic 30 minutes before skin incision): Antibiotic diluted in 10 ml syringe 30 minutes before skin incision and after cord clamping, 0.9% NaCl in 10 ml syringe will be administered intravenously within 15 seconds.

Group 2 (prophylactic antibiotic after cord clamping): 30 minutes before the skin incision, 0.9% NaCl in a 10 ml injector and after the cord is clamped, the antibiotic diluted in a 10 ml syringe will be administered intravenously within 15 seconds.

Intraoperative nausea-retching-vomiting episodes (0 = No symptoms, 1: Nausea (uncomfortable feeling with vomiting), 2: Gag (vomiting effort in which gastric contents cannot be expelled), 3: Vomiting (Gastric contents are forced by mouth. ejection)] will be recorded. Nausea scores will be evaluated on the verbal analog scale (VAS) with 11 points (0 = no nausea, 10 = the most severe nausea). Before anesthesia, all patients will be informed about the verbal analog scale (VAS) for nausea. VAS 1-3 = Mild Nausea, VAS 4-6 = Moderate nausea, VAS 7-10 = Severe nausea. Evaluations will be made at certain time intervals.

Before CSEA application Time interval between CSEA application and fetus discharge Time interval between fetus exit and expulsion of the uterus Time interval between expulsion of the uterus and insertion into the abdomen Time interval between insertion of the uterus in the abdomen and closing the fascia Time interval between fascia closure and skin closure Time interval between skin closure and patient transport to the recovery unit Nausea-retching-vomiting episodes, current systolic/diastolic blood pressure values, nausea-vomiting scores, antiemetic and / or ephedrine requirement, amount of intravenous fluid infused will be recorded.

Intraoperative prophylactic antibiotic use is considered as one of the possible causes of intraoperative nausea and vomiting in patients who underwent cesarean section under regional anesthesia. We believe that the results of our study can make contribution on both intraoperative nausea-vomiting etiology in cases undergoing cesarean section under regional anesthesia and the steps that can be taken to prevent it.

Being tested
Antibiotic prophylaxis timing (before skin incision and after cord clamping) for caesarean section
Keywords
antibiotic prophylaxis, nausea, vomiting, cesarean section, egional anesthesia
Medical subject headings
Nausea, Vomiting

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Antibiotic prophylaxis timing (before skin incision and after cord clamping) for caesarean sectionDrug

Study groups in NCT04697277
Study groupRoleWhat they receive
Group 1Active comparatorGroup 1 (Prophylactic antibiotic 30 minutes before skin incision): Antibiotic diluted in 10 ml syringe 30 minutes before skin incision and after cord clamping, 0.9% NaCl in 10 ml syringe will be administered intravenously within 15 seconds.
Receives: Drug: Antibiotic prophylaxis timing (before skin incision and after cord clamping) for caesarean section
Group 2Active comparatorGroup 2 (prophylactic antibiotic after cord clamping): 30 minutes before the skin incision, 0.9% NaCl in a 10 ml injector and after the cord is clamped, the antibiotic diluted in a 10 ml syringe will be administered intravenously within 15 seconds.
Receives: Drug: Antibiotic prophylaxis timing (before skin incision and after cord clamping) for caesarean section

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Intraoperative nausea-retching-vomiting episodes

    0 = No symptoms, 1: Nausea (uncomfortable feeling with vomiting), 2: Gag (vomiting effort in which gastric contents cannot be expelled), 3: Vomiting (Gastric contents are forced by mouth. ejection)

    Measured: Intraoperative

Secondary outcomes (1)
  1. Nausea score

    Nausea score will be evaluated on the verbal analog scale (VAS) with 11 points (0 = no nausea, 10 = the most severe nausea). Before anesthesia, all patients will be informed about the verbal analog scale (VAS) for nausea. VAS 1-3 = Mild Nausea, VAS 4-6 = Moderate nausea, VAS 7-10 = Severe nausea.

    Measured: Intraoperative

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted6 Jan 2021
  2. Study start20 Aug 2015
  3. Primary completion30 Apr 2021 (estimated)
  4. Study completion30 May 2021 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
120 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04697277
Sponsor's protocol ID
KA15/197
Status last verified
Jan 2021
First submitted
5 Jan 2021
Last updated
6 Jan 2021
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Publications

  • Balki M, Carvalho JC. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. Int J Obstet Anesth. 2005 Jul;14(3):230-41. doi: 10.1016/j.ijoa.2004.12.004.

    PubMed 15935649
  • Fujii Y. Retraction Notice: Prevention of emetic episodes during cesarean delivery performed under regional anesthesia in parturients. Curr Drug Saf. 2007 Jan;2(1):25-32. doi: 10.2174/157488607779315381.

    PubMed 18690947
  • Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000;(2):CD001136. doi: 10.1002/14651858.CD001136.

    PubMed 10796247
  • Costantine MM, Rahman M, Ghulmiyah L, Byers BD, Longo M, Wen T, Hankins GD, Saade GR. Timing of perioperative antibiotics for cesarean delivery: a metaanalysis. Am J Obstet Gynecol. 2008 Sep;199(3):301.e1-6. doi: 10.1016/j.ajog.2008.06.077.

    PubMed 18771991
  • Sullivan SA, Smith T, Chang E, Hulsey T, Vandorsten JP, Soper D. Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventing postcesarean infectious morbidity: a randomized, controlled trial. Am J Obstet Gynecol. 2007 May;196(5):455.e1-5. doi: 10.1016/j.ajog.2007.03.022.

    PubMed 17466699
  • Thigpen BD, Hood WA, Chauhan S, Bufkin L, Bofill J, Magann E, Morrison JC. Timing of prophylactic antibiotic administration in the uninfected laboring gravida: a randomized clinical trial. Am J Obstet Gynecol. 2005 Jun;192(6):1864-8; discussion 1868-71. doi: 10.1016/j.ajog.2004.12.063.

    PubMed 15970833
  • Committee opinion no. 465: antimicrobial prophylaxis for cesarean delivery: timing of administration. Obstet Gynecol. 2010 Sep;116(3):791-792. doi: 10.1097/AOG.0b013e3181f68086.

    PubMed 20733474
  • Raghunathan K, Connelly NR, Friderici J, Naglieri-Prescod D, Joyce R, Prasanna P, Ponnusamy N. Unwarranted variability in antibiotic prophylaxis for cesarean section delivery: a national survey of anesthesiologists. Anesth Analg. 2013 Mar;116(3):644-8. doi: 10.1213/ANE.0b013e318276cf72. Epub 2013 Feb 11.

    PubMed 23400990
  • Jenkins JG, Khan MM. Anaesthesia for Caesarean section: a survey in a UK region from 1992 to 2002. Anaesthesia. 2003 Nov;58(11):1114-8. doi: 10.1046/j.1365-2044.2003.03446.x.

    PubMed 14616600
  • Voigt M, Frohlich CW, Huttel C, Kranke P, Mennen J, Boessneck O, Lenz C, Erbes T, Ernst J, Kerger H. Prophylaxis of intra- and postoperative nausea and vomiting in patients during cesarean section in spinal anesthesia. Med Sci Monit. 2013 Nov 14;19:993-1000. doi: 10.12659/MSM.889597.

    PubMed 24226381
  • Dasgupta M, Biswas BN, Chatterjee S, Mazumder P, Bhanja Chowdhury M. Randomized, placebo-controlled trial of granisetron for control of nausea and vomiting during cesarean delivery under spinal anesthesia. J Obstet Gynaecol India. 2012 Aug;62(4):419-23. doi: 10.1007/s13224-012-0291-0. Epub 2012 Oct 16.

    PubMed 23904702
  • Watcha MF. The cost-effective management of postoperative nausea and vomiting. Anesthesiology. 2000 Apr;92(4):931-3. doi: 10.1097/00000542-200004000-00007. No abstract available.

    PubMed 10754609
  • Koch KL, Frissora CL. Nausea and vomiting during pregnancy. Gastroenterol Clin North Am. 2003 Mar;32(1):201-34, vi. doi: 10.1016/s0889-8553(02)00070-5.

    PubMed 12635417
  • Manullang TR, Viscomi CM, Pace NL. Intrathecal fentanyl is superior to intravenous ondansetron for the prevention of perioperative nausea during cesarean delivery with spinal anesthesia. Anesth Analg. 2000 May;90(5):1162-6. doi: 10.1097/00000539-200005000-00030.

    PubMed 10781472
  • Demirhan A, Tekelioglu YU, Akkaya A, Ozlu T, Yildiz I, Bayir H, Kocoglu H, Duran B. Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia. Afr Health Sci. 2013 Jun;13(2):475-82. doi: 10.4314/ahs.v13i2.39.

    PubMed 24235952

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Antibiotic prophylaxis timing (before skin incision and after cord clamping) for caesarean section in people with Intraoperative Nausea-retching-vomiting Episodes and Nausea Scores Will be Evaluated on the Verbal Analog Scale (VAS), run by Baskent University Ankara Hospital at 1 site in Turkey (Türkiye).

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 6 Jan 2021. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Bahattin Tuncali (+90 232 2411000, tuncali.bahattin@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Intraoperative nausea-retching-vomiting episodes (time frame: Intraoperative). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04697277, which also lists 19 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Jan 2021.

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