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Dexamethasone versus ondansetron in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: a meta-analysis of randomized controlled trials.

Wang XX, Zhou Q, Pan DB, Deng HW, Zhou AG, Huang FR, Guo HJ - BMC Anesthesiol (2015)

Bottom Line: We calculated pooled risk ratios (RR) and 95 % CIs using random- and fixed-effects models.There was no significant difference in the postoperative anti-emetics used (RR, 0.90; 95 % CI, 0.67-1.19; P = 0.45).Dexamethasone was as effective and as safe as ondansetron in preventing PONV.

View Article: PubMed Central - PubMed

Affiliation: Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou, Jiangsu, China. wxxxzyxy2013@163.com.

ABSTRACT

Background: Dexamethasone is an antiemetic alternative to ondansetron. We aimed to compare the effects of dexamethasone and ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery.

Methods: We searched PubMed, Embase, Medline and Cochrane Library (from inception to July 2014) for eligible studies. The primary outcome was the incidence of PONV during the first 24 h after surgery. The secondary outcomes included PONV in the early postoperative stage (0-6 h), PONV in the late postoperative stage (6-24 h), and the postoperative anti-emetics used at both stages. We calculated pooled risk ratios (RR) and 95 % CIs using random- and fixed-effects models.

Results: Seven trials involving 608 patients were included in this meta-analysis, which found that dexamethasone had a comparable effectiveness in preventing PONV (RR, 0.91; 95 % CI, 0.73-1.13; P = 0.39) with that of ondansetron within 24 h of laparoscopic surgery, with no evidence of heterogeneity among the studies (I(2) = 0 %; P = 0.71). In the early postoperative stage (0-6 h), ondansetron was better at decreasing PONV than dexamethasone (RR, 1.71; 95 % CI, 1.05-2.77; P = 0.03), while in the late postoperative stage (6-24 h), dexamethasone was more effective in preventing PONV than ondansetron (RR, 0.51; 95 % CI, 0.27-0.93; P = 0.03). There was no significant difference in the postoperative anti-emetics used (RR, 0.90; 95 % CI, 0.67-1.19; P = 0.45).

Conclusions: Dexamethasone was as effective and as safe as ondansetron in preventing PONV. Dexamethasone should be encouraged as an alternative to ondansetron for preventing PONV in patients undergoing laparoscopic surgery.

No MeSH data available.


Related in: MedlinePlus

Forest plot of Sensitivity Analysis in the early postoperative stage (0–6 h)
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Fig4: Forest plot of Sensitivity Analysis in the early postoperative stage (0–6 h)

Mentions: Furthermore, we conducted a subgroup meta-analysis based on the postoperative stage to explore the efficacy of dexamethasone for the prevention of PONV compared with that of ondansetron. Dexamethasone was not superior to ondansetron in preventing PONV in the early postoperative stage (0–6 h) (RR, 1.22, 95 % CI 0.87-1.73; P = 0.25), but there was significant heterogeneity in these data among the studies (I2 = 65 %; P = 0.02). After the exclusion of two trials that did not have any occurrence of PONV in the late postoperative stage (6–24 h), dexamethasone was found to be superior to ondansetron in preventing PONV in the late postoperative stage (RR, 0.51, 95 % CI, 0.27-0.93; P = 0.03), and the heterogeneity among the studies was more moderate for these data than for the data for the early postoperative stage (I2 = 37 %; P = 0.20) (Fig. 3). Subsequently, a sensitivity analysis was carried out to explore the potential source of heterogeneity in the early postoperative stage. As shown in Fig. 4, the results of Nita D’souza et al. [1] were completely out of the range of those of the other studies and this probably contributed to the observed heterogeneity. After excluding this study, the results suggested that compared with dexamethasone, ondansetron was associated with a decreased of incidence PONV (RR 1.71, 95 % CI, 1.05-2.77; P = 0.03).Fig. 3


Dexamethasone versus ondansetron in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: a meta-analysis of randomized controlled trials.

Wang XX, Zhou Q, Pan DB, Deng HW, Zhou AG, Huang FR, Guo HJ - BMC Anesthesiol (2015)

Forest plot of Sensitivity Analysis in the early postoperative stage (0–6 h)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536735&req=5

Fig4: Forest plot of Sensitivity Analysis in the early postoperative stage (0–6 h)
Mentions: Furthermore, we conducted a subgroup meta-analysis based on the postoperative stage to explore the efficacy of dexamethasone for the prevention of PONV compared with that of ondansetron. Dexamethasone was not superior to ondansetron in preventing PONV in the early postoperative stage (0–6 h) (RR, 1.22, 95 % CI 0.87-1.73; P = 0.25), but there was significant heterogeneity in these data among the studies (I2 = 65 %; P = 0.02). After the exclusion of two trials that did not have any occurrence of PONV in the late postoperative stage (6–24 h), dexamethasone was found to be superior to ondansetron in preventing PONV in the late postoperative stage (RR, 0.51, 95 % CI, 0.27-0.93; P = 0.03), and the heterogeneity among the studies was more moderate for these data than for the data for the early postoperative stage (I2 = 37 %; P = 0.20) (Fig. 3). Subsequently, a sensitivity analysis was carried out to explore the potential source of heterogeneity in the early postoperative stage. As shown in Fig. 4, the results of Nita D’souza et al. [1] were completely out of the range of those of the other studies and this probably contributed to the observed heterogeneity. After excluding this study, the results suggested that compared with dexamethasone, ondansetron was associated with a decreased of incidence PONV (RR 1.71, 95 % CI, 1.05-2.77; P = 0.03).Fig. 3

Bottom Line: We calculated pooled risk ratios (RR) and 95 % CIs using random- and fixed-effects models.There was no significant difference in the postoperative anti-emetics used (RR, 0.90; 95 % CI, 0.67-1.19; P = 0.45).Dexamethasone was as effective and as safe as ondansetron in preventing PONV.

View Article: PubMed Central - PubMed

Affiliation: Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou, Jiangsu, China. wxxxzyxy2013@163.com.

ABSTRACT

Background: Dexamethasone is an antiemetic alternative to ondansetron. We aimed to compare the effects of dexamethasone and ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery.

Methods: We searched PubMed, Embase, Medline and Cochrane Library (from inception to July 2014) for eligible studies. The primary outcome was the incidence of PONV during the first 24 h after surgery. The secondary outcomes included PONV in the early postoperative stage (0-6 h), PONV in the late postoperative stage (6-24 h), and the postoperative anti-emetics used at both stages. We calculated pooled risk ratios (RR) and 95 % CIs using random- and fixed-effects models.

Results: Seven trials involving 608 patients were included in this meta-analysis, which found that dexamethasone had a comparable effectiveness in preventing PONV (RR, 0.91; 95 % CI, 0.73-1.13; P = 0.39) with that of ondansetron within 24 h of laparoscopic surgery, with no evidence of heterogeneity among the studies (I(2) = 0 %; P = 0.71). In the early postoperative stage (0-6 h), ondansetron was better at decreasing PONV than dexamethasone (RR, 1.71; 95 % CI, 1.05-2.77; P = 0.03), while in the late postoperative stage (6-24 h), dexamethasone was more effective in preventing PONV than ondansetron (RR, 0.51; 95 % CI, 0.27-0.93; P = 0.03). There was no significant difference in the postoperative anti-emetics used (RR, 0.90; 95 % CI, 0.67-1.19; P = 0.45).

Conclusions: Dexamethasone was as effective and as safe as ondansetron in preventing PONV. Dexamethasone should be encouraged as an alternative to ondansetron for preventing PONV in patients undergoing laparoscopic surgery.

No MeSH data available.


Related in: MedlinePlus