Prophylactic antibiotic timing for cesarean section under regional anesthesia investigated for impact on intraoperative nausea and vomiting.

Intraoperative nausea and vomiting (IONV) is a common and distressing complication during cesarean section (C/S) under regional anesthesia, affecting 30-80% of patients. Current standard-of-care often involves simultaneous administration of oxytocin and prophylactic antibiotics, which are both identified as potential risk factors for IONV. This study addresses a critical gap by investigating whether the timing of prophylactic antibiotic administration—specifically, before skin incision versus after umbilical cord clamping—can mitigate the incidence and severity of IONV, thereby improving patient experience during C/S.

This prospective, randomized, double-blind study enrolled 120 pregnant women (≥ 37 gestational weeks) undergoing elective C/S under regional anesthesia. Participants were divided into two groups: Group 1 received prophylactic antibiotic diluted in 10 ml IV 30 minutes before skin incision and 0.9% NaCl after cord clamping. Group 2 received 0.9% NaCl 30 minutes before incision and antibiotic diluted in 10 ml IV after cord clamping. Both IV administrations were completed within 15 seconds. The primary endpoint was the recording of intraoperative nausea-retching-vomiting episodes using a 0-3 scale, and nausea scores were evaluated on a verbal analog scale (VAS).