Objectives: Nausea and vomiting remain as “the big little problem” in caesarean delivery under spinal anesthesia. Incidence of nausea-vomiting during and immediately after surgery in spinal anesthesia is high. It is distressing to both physically and mentally to patient and disturbing to the surgeon and anesthesiologist. Purpose of this study was to compare the clinical efficacy of intrathecal fentanyl and midazolam for prevention of nausea-vomiting during caesarean delivery under spinal anesthesia.

Methods: A prospective randomized double blind study conducted in women aged between 18-31 years (physical status ASA I) scheduled to undergo elective caesarean delivery under spinal anesthesia. Subjects were randomly divided into three equal groups.Alongwith hyperbaric bupivacaine(0.5%), Group A received 0.5ml Normal Saline, Group B received 2mgmidazolam and Group C received 12.5mcg fentanyl intrathecally.

Results: Incidence of nausea-vomiting in Group C and Group B was significantly lower than Group A, and was lower in Group C compared to Group B(Group A>B>C).

Discussion: The results of our study revealed that both intrathecal fentanyl and midazolam significantly decrease the incidence of intraoperative and early post delivery nausea-vomiting in comparison with Normal Saline. By providing good intra and postoperative analgesia, intrathecal fentanyl and midazolam decrease discomfort from peritoneal manipulations, which may initiate emesis. Nausea-vomiting was assessed according to Belville’s score.

Conclusion: Co-administration of intrathecal fentanyl 12.5mcg or midazolam 2mg reduces the incidence and severity of nausea-vomiting.