Efficacy of Ginger on Intraoperative and Postoperative Nausea and Vomiting in Elective Cesarean Section Patients

Two hundred and thirty nine ASA class I and II patients, scheduled for elective c-section
will be assigned randomly to receive either 1g ginger tablet PO (Group 1) or 1 g placebo PO
(Group 2) preoperatively, immediately before surgery. The usual preoperative anti-emetic and
antacid regimen will be continued for both groups. Initial blood pressure, pulse and
hemoglobin and hematocrit will be documented by the researcher prior to the arrival of the
patient into the operating room. A baseline questionnaire will be given to the patients to
assess risk factors for nausea and vomiting. Questions will include: age, BMI, parity, weeks
gestation, h/o seasickness, h/o of hyperemesis gravidrum in this or prior pregnancies, h/o
PONV, medical problems, any medication used within past 24 hrs, education and occupation.

Intraoperatively, both groups will receive combined spinal-epidural anesthesia in the usual
manner. All standard monitoring will be applied and vital signs recorded for the entirety of
the procedure. The number and dose of ephedrine or phenylephrine boluses and the number and
severity of nausea episodes (using a Visual Analog Scale (VANS)) and number of vomiting
episodes will be noted. In addition the following will be recorded: if uterus was
exteriorized, any medications used by the anesthesiologist (other than ephedrine and
phenylephrine), and estimated blood loss.

Postoperatively, patients will receive either a one time dose of the 1g ginger PO (Group 1)
or 1 g placebo PO (Group 2) 2 hours after entering the postanesthesia care unit (PACU).
Thirty minutes after the medication is given, patients will be asked to rate their nausea,
level of analgesia, and level of pruritus on a VANS, and vomiting episodes will be recorded.
Medications given for nausea will be continued in the post-operative period for both groups.
The doses of Zofran will be counted in the 24 hr postoperative period. Twenty-four hours
after surgery, blood will be drawn to assess hemoglobin and hematocrit as well as to assess
platelet function.

Inclusion Criteria:

- Healthy (i.e., ASA I, or II) patients presenting for planned c-section at New York
Methodist Hospital

- Signed informed consent

Exclusion Criteria:

- They are unable or unwilling to take part in the study

- They have a history of an allergy to any medications used including ginger

- They have had any gastrointestinal surgery on the stomach, small intestine, or gall
bladder.

- They have any history of bleeding disorder, (i.e., Hemophilia A/B, ITP, etc.)

- They have a contraindication to intrathecal or epidural anesthesia. ( i.e., Arnold-
Chiari malformation, etc.)

- They are unable to understand instructions or questions related to study

- ASA III or IV patients