Dexamethasone combined with other antiemetics versus single antiemetics for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: An updated systematic review and meta-analysis. (December 2016)

• Record Type: Journal Article
• Authors: Awad, Kamal; Ahmed, Hussien; Abushouk, Abdelrahman Ibrahim; Al Nahrawi, Safwat; Elsherbeny, Mohammed Yasser; Mustafa, Salma Muhammad; Attia, Attia
• Is Part Of: International journal of surgery. Volume 36:Part A(2016)
• Page Start: 152
• Page End: 163
• Publication Date: 2016-12
• Subjects: Antiemetics -- Postoperative nausea and vomiting -- Laparoscopic cholecystectomy -- Meta-analysis; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2016.10.034
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Objective: A systematic review and meta-analysis of published randomized controlled trials was performed to update the present evidence about the safety and efficacy of dexamethasone combined with other antiemetics versus single antiemetics for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Methods: A computer literature search of PubMed, Scopus, Web of Science and Embase was conducted to identify the relevant randomized controlled trials. In addition, a manual search of reference lists of the retrieved articles was conducted. Relevant outcomes were pooled as odds ratio (OR) by RevMan version 5.3 for windows. Results: Pooled data from 14 RCTs (1542 patients) favored dexamethasone combined with other antiemetics over single antiemetics as a prophylaxis against postoperative nausea and vomiting after laparoscopic cholecystectomy in the early postoperative period (OR = 0.39, 95% CI [0.27 to 0.54], p < 0.00001), late postoperative period (OR = 0.36, 95% CI [0.23 to 0.56], p < 0.00001), and overall postoperative period (OR = 0.34, 95% CI [0.23 to 0.51], p < 0.00001). Subsequently, rescue antiemetic usage was significantly lower in the combination group (OR = 0.25, 95% CI [0.16 to 0.41], p < 0.00001). Subgroup analysis showed that all combinations of dexamethasone and other antiemetics were superior to corresponding singel antiemetics except for the combination of dexamethasone and ramosetron which was not superior to ramosetron alone in all postoperative periods and the combination of dexamethasone and granisetron which was not superior to granisetron alone in the early postoperative period (OR = 0.26, 95% CI [0.07 to 1.01], p = 0.05). For all adverse events, there was no significant difference between the two groups. Conclusion: Dexamethasone combined with other antiemetics provided better prophylaxis than single antiemetics against postoperative nausea and vomiting after laparoscopic cholecystectomy. The underlying mechanism of dexamethasone action and its optimal dose should be further investigated. Highlights: Our meta-analysis shows that adding dexamethasone to antiemetic drugs increases their prophylactic effect against PONV after LC. The need for a rescue antiemetic was significantly lower in the combination group, compared to single antiemetic group. Future trials should define the optimal prophylactic dose and the underlying mechanism of dexamethasone antiemetic effect.