Management of post-operative pain by metoclopramide in patients undergoing cesarean section: A double-blinded randomized clinical trial.

Abstract

Objective: Poor post-operative pain management after cesarean section (C-section) can have adverse effects on the mother and baby and is associated with increased opioid intake. This study aims to evaluate the effects of the dopamine antagonist, metoclopramide, on the management of post-operative pain among women undergoing elective C-sections.

Method: This double-blinded randomized study included women who underwent C-sections at our center. The patients were divided into an intervention group and a control group. The intervention group received 20 mg metoclopramide, whereas the control group was given 2 cc of distilled water as a placebo, intravenously, post-operatively, before the closing of the surgical site. At 2, 4, 6, 8, 12, and 24 post-operative hours, data regarding pain (measured via a visual analog scale), nausea and vomiting, and resumption of physical activity were obtained along with the demographic information of the patients.

Results: Fifty patients were included in both groups. The mean age, body mass index, number of previous deliveries, education, smoking status, and number of previous C-sections were not significantly different between the two groups. Metoclopramide reduced early post-cesarean pain (Visual Analog Scale [VAS]: 7.38 vs 8.48 at 2 hours, *p < 0.001) and morphine use (18.7 mg vs 22.3 mg, *p = 0.032), with transient antiemetic effects at 2 hours. The mean VAS scores at 2 and 4 post-operative hours were significantly different between both groups, respectively. The incidence of nausea and vomiting was significantly different at the second post-operative hour only.

Conclusion: Metoclopramide significantly reduced early post-operative pain and opioid requirements, with reductions exceeding minimal clinically important difference thresholds. While statistically robust, these benefits should be weighed against its transient antiemetic effects and the need for larger trials to confirm functional recovery benefits.