Effects of Ginger Extract plus Ondansetron on Postoperative Nausea and Vomiting in Patients Undergoing Cesarean Section with Spinal Anesthesia Supplemented by Intrathecal Morphine: A Randomized Controlled Trial

Wanida Chongarunngamsang, MD¹ ORCID , Varatsawan Kulongkhananot, MD¹ ORCID , Napapon Gulrawong, RN² ORCID , Pornsri Pinkaew, RN² ORCID , Dujduen Sriramatr, MD¹ ORCID

Affiliation : ¹ Department of Anesthesiology, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhon Nayok, Thailand; ² HRH Princess Maha Chakri Sirindhorn Medical Center, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand

Abstract / Graphical Abstract
Objective: To evaluate the efficacy of oral ginger extract plus ondansetron in preventing postoperative nausea and vomiting (PONV) induced by intrathecal morphine (ITM) in parturients undergoing cesarean section.
Materials and Methods: This double-blind, randomized, placebo-controlled trial included 40 parturients scheduled for elective cesarean under spinal anesthesia with ITM who were randomized to receive either ginger extract capsules (1,000 mg per dose, cumulative dose 3,000 mg) or placebo capsules at three time points. The primary outcome was PONV severity assessed using a visual analog scale (VAS) at 0, 6, 12, and 24 hours postoperatively. Secondary outcomes included PONV incidence, rescue antiemetic use, and adverse events.
Results: The ginger group showed a non-significant trend toward reduced PONV severity at 12 and 24 hours postoperatively and slightly reduced antiemetic use (50% vs. 55%, p=0.515). No statistically significant differences were observed in vomiting incidence, total vomiting episodes, ondansetron consumption, or adverse effects between groups.
Conclusion: Oral ginger extract did not provide additional benefit in reducing ITM-induced nausea and vomiting beyond standard ondansetron treatment. Although the severity of PONV and antiemetic use were modestly lower in the ginger group, the differences were not statistically significant. Further studies with larger sample sizes are warranted.

Received 14 July 2025 | Revised 5 June 2026 | Accepted 10 June 2026
J Med Assoc Thai 2026;109(10):793-800
DOI: 10.35755/jmedassocthai.2026.10.03365

Keywords : Cesarean section; Ginger; Intrathecal morphine; Postoperative nausea and vomiting; Spinal anesthesia


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