Post-operative nausea and vomiting prophylaxis: A meta-review on systematic reviews and meta-analyses
Abstract
Introduction: Postoperative nausea and vomiting (PONV) are common complications in surgical patients undergoing general anesthesia, and multiple strategies have been suggested to prevent them.
Objective: To describe the available evidence on the effectiveness of pharmacological and non-pharmacological strategies for preventing PONV in adults undergoing surgery under general anesthesia, as reported in previous meta-analyses and systematic reviews.
Methodology: An overview of systematic reviews and meta-analyses was conducted. Searches were performed in PubMed, EBSCO, EMBASE, Cochrane Database, Science Direct, and Scopus, without restrictions as to gender, clinical condition, or date of publication, including articles in Spanish, French, and English only. Two reviewers independently and in duplicate did the screening, data extraction, quality evaluation, and risk of bias assessment according to AMSTAR-2. The PRISMA and PRIOR statements were followed for reporting. PROSPERO registration number CRD42021251999.
Results: Out of 80 candidate articles, three were viable for meta-analysis. 1.5 mg to 18 mg doses of Dexamethasone showed a significant reduction in the risk of PONV, with a RR of 0.48 (95 % CI 0.41-0.57; p<0.001), I2=63 % (p=0.07), and a NNTc of 5 and 7. Other effective strategies included the use of acoustic stimulation/acupuncture/acupressure, 5HT3 antagonists, NK1 antagonists, gabapentinoids, haloperidol, droperidol, metoclopramide, midazolam, mirtazapine, among others. The risk of publication bias was low.
Conclusion: Different strategies are effective for PONV prophylaxis in surgeries under general anesthesia. Dexamethasone shows the best available evidence at the moment. The documented methodological quality suggests the need for better studies to establish the effectiveness of the strategies.
References
Teunkens A, Vanhaecht K, Vermeulen K, Fieuws S, Van de Velde M, Rex S, et al. Measuring satisfaction and anesthesia related outcomes in a surgical day care centre: A three-year single-centre observational study. J Clin Anesth. 2017;43:15-23. doi: https://doi.org/10.1016/j.jclinane.2017.09.007.
Parra-Sánchez I, Abdallah R, You J, Fu AZ, Grady M, Cummings K, et al. A time-motion economic analysis of postoperative nausea and vomiting in ambulatory surgery. Canadian J Anesthesia. 2012;59(4):366-75. doi: https://doi.org/10.1007/s12630-011-9660-x.
Öbrink E, Jildenstål P, Oddby E, Jakobsson JG. Post-operative nausea and vomiting: Update on predicting the probability and ways to minimize its occurrence, with focus on ambulatory surgery. International Journal of Surgery. 2015;15:100-6. doi: https://doi.org/10.1016/J.IJSU.2015.01.024.
Look X, Mok MUS, Tay YS, Abdullah HR. How do Singapore patients view post-anaesthesia adverse outcomes? A single-centre willingness-to-pay study. Singapore Med J. 2018;59(5):264-70. doi: https://doi.org/10.11622/smedj.2017078.
Smith HS, Smith EJ, Smith BR. Postoperative nausea and vomiting. Ann Palliat Med. 2012;1(2):94-102. doi: https://doi.org/10.3978/j.issn.2224-5820.2012.07.05.
Carlisle JB. A meta-analysis of prevention of postoperative nausea and vomiting: Randomised controlled trials by Fujii et al. compared with other authors. Anaesthesia. 2012;67(10):1076-90. doi: https://doi.org/10.1111/j.1365-2044.2012.07232.x.
Carlisle JB. False individual patient data and zombie randomised controlled trials submitted to Anaesthesia. Anaesthesia. 2021;76(4):472-9. doi: https://doi.org/10.1111/anae.15263.
Carlisle JB. Data fabrication and other reasons for non-random sampling in 5087 randomised, controlled trials in anaesthetic and general medical journals. Anaesthesia. 2017;72(8):944-52. doi: https://doi.org/10.1111/anae.13938.
Gan TJ, Belani KG, Bergese S, Chung F, Diemunsch P, Habib AS, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020;131(2):411-48. doi: https://doi.org/10.1213/ANE.0000000000004833.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. The BMJ. 2021;372. doi: https://doi.org/10.1136/bmj.n71.
Ministerio de Salud - República de Colombia. Resolución 8430 de 1993. 1993:1-19.
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ (Online). 2017;358:1-9. doi: https://doi.org/10.1136/bmj.j4008.
Gates M, Gates A, Duarte G, Cary M, Becker M, Prediger B, et al. Quality and risk of bias appraisals of systematic reviews are inconsistent across reviewers and centers. J Clin Epidemiol. 2020;125:9-15. doi: https://doi.org/10.1016/j.jclinepi.2020.04.026.
Marx A. Numbers needed to treat derived from meta-analysis: a word of caution. Evid Based Med. 2003;8(2):36-7. doi: https://doi.org/10.1136/ebm.8.2.36.
Altman DG, Deeks JJ. Meta-analysis, Simpson’s paradox, and the number needed to treat. BMC Med Res Methodol. 2002;2:1-5. doi: https://doi.org/10.1186/1471-2288-2-3.
Moore RA, Gavaghan DJ, Edwards JE, Wiffen P, McQuay HJ. Pooling data for number needed to treat: No problems for apples. BMC Med Res Methodol. 2002;2:1-4. doi: https://doi.org/10.1186/1471-2288-2-2.
The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions | Cochrane Training. [cited: 2022 May 30]. Available at: https://training.cochrane.org/handbook/current.
Munder T, Brütsch O, Leonhart R, Gerger H, Barth J. Researcher allegiance in psychotherapy outcome research: An overview of reviews. Clin Psychol Rev. 2013;33(4):501-11. doi: https://doi.org/10.1016/j.cpr.2013.02.002.
Cooper H, Koenka AC. Unique challenges and opportunities when research syntheses are the principal elements of new integrative scholarship. American Psychologist. 2012;67(6):446-62. doi: https://doi.org/10.1037/A0027119.
The Cochrane Collaboration. Chapter 15: Interpreting results and drawing conclusions | Cochrane Training. [cited: 2022 Jun 29]. Available at: https://training.cochrane.org/handbook/current/chapter-15.
Doleman B, Read D, Lund JN, Williams JP. Preventive acetaminophen reduces postoperative opioid consumption, vomiting, and pain scores after surgery: Systematic review and meta-analysis. Reg Anesth Pain Med. 2015:706-12. doi: https://doi.org/10.1097/AAP.0000000000000311.
Chen J, Tu Q, Miao S, Zhou Z, Hu S. Transcutaneous electrical acupoint stimulation for preventing postoperative nausea and vomiting after general anesthesia: A meta-analysis of randomized controlled trials. International J Surg. 2020;73:57-64. doi: https://doi.org/10.1016/j.ijsu.2019.10.036.
Cheong KB, Zhang J, Huang Y, Zhang Z. The effectiveness of acupuncture in prevention and treatment of postoperative nausea and vomiting - A systematic review and meta-analysis. PLoS One. 2013;8(12):e82474. doi: https://doi.org/10.1371/journal.pone.0082474.
Ahn E, Choi G, Kang H, Baek C, Jung Y, Woo Y, et al. Palonosetron and ramosetron compared for effectiveness in preventing postoperative nausea and vomiting: A systematic review and meta-analysis. PLoS One. 2016;11(12):e0168509. doi: https://doi.org/10.1371/journal.pone.0168509.
Mihara T, Tojo K, Uchimoto K, Morita S, Goto T. Reevaluation of the effectiveness of ramosetron for preventing postoperative nausea and vomiting: a systematic review and meta-analysis. Anesth Analg. 2013;117(2):329-39. doi: https://doi.org/10.1213/ANE.0b013e31829847a1.
Liu M, Zhang H, Du BX, Xu FY, Zou Z, Sui B, et al. Neurokinin-1 receptor antagonists in preventing postoperative nausea and vomiting. Medicine (United States). 2015;94(19):1-15. doi: https://doi.org/10.1097/MD.0000000000000762.
Singh PM, Borle A, Rewari V, Makkar JK, Trikha A, Sinha AC, et al. Aprepitant for postoperative nausea and vomiting: A systematic review and meta-analysis. Postgrad Med J. 2016;92(1084):87-98. doi: https://doi.org/10.1136/postgradmedj-2015-133515.
Chen CC, Siddiqui FJ, Chen TL, Chan ESY, Tam KW. Dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing thyroidectomy: Meta-analysis of randomized controlled trials. World J Surg. 2012;36(1):61-8. doi: https://doi.org/10.1007/s00268-011-1343-9.
Fan Z, Ma J, Kuang M, Zhang L, Han B, Yang B, et al. The efficacy of dexamethasone reducing postoperative pain and emesis after total knee arthroplasty: A systematic review and meta-analysis. International Journal of Surgery. 2018;52:149-55. doi: https://doi.org/10.1016/j.ijsu.2018.02.043.
Li B, Wang H. Dexamethasone reduces nausea and vomiting but not pain after thyroid surgery: A meta-analysis of randomized controlled trials. Medical Science Monitor. 2014;20:2837-45. doi: https://doi.org/10.12659/MSM.891390.
Yang Q, Zhang Z, Xin W, Li A. Preoperative intravenous glucocorticoids can decrease acute pain and postoperative nausea and vomiting after total hip arthroplasty: A PRISMA-compliant meta-analysis. Medicine (United States). 2017;96(47):1-8. doi: https://doi.org/10.1097/MD.0000000000008804.
Zou Z, Jiang Y, Xiao M, Zhou R. The impact of prophylactic dexamethasone on nausea and vomiting after thyroidectomy: A systematic review and meta-analysis. PLoS One. 2014;9(10):e109582. doi: https://doi.org/10.1371/journal.pone.0109582.
Wang G, Zhang L, Lou S, Chen Y, Cao Y, Wang R, et al. Effect of dexmedetomidine in preventing postoperative side effects for laparoscopic surgery: A meta-analysis of randomized controlled trials and trial sequential analysis. Medicine (United States). 2016;95(10):1-10. doi: https://doi.org/10.1097/MD.0000000000002927.
Alayed N, Alghanaim N, Tan X, Tulandi T. Preemptive use of gabapentin in abdominal hysterectomy: A systematic review and meta-analysis. Obstetrics and Gynecology. 2014:1221-9. doi: https://doi.org/10.1097/AOG.0000000000000289.
Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, Leeprakobboon K, Leelasettagool C. The efficacy of ginger for the prevention of postoperative nausea and vomiting: A meta-analysis. Am J Obstet Gynecol. 2006;194(1):95-9. doi: https://doi.org/10.1016/j.ajog.2005.06.046.
Tóth B, Lantos T, Hegyi P, Viola R, Vasas A, Benkő R, et al. Ginger (Zingiber officinale): An alternative for the prevention of postoperative nausea and vomiting. A meta-analysis. Phytomedicine. 2018;50(April):8-18. doi: https://doi.org/10.1016/j.phymed.2018.09.007.
Jewer JK, Wong MJ, Bird SJ, Habib AS, Parker R, George RB. Supplemental perioperative intravenous crystalloids for postoperative nausea and vomiting. Cochrane Database of Systematic Reviews. 2019. doi: https://doi.org/10.1002/14651858.CD012212.pub2.
Lee MJ, Lee C, Kang H, Kim H. The impact of crystalloid versus colloid fluids on postoperative nausea and vomiting: A systematic review and meta-analysis of randomized controlled trials. J Clin Anesth. 2020;62. doi: https://doi.org/10.1016/j.jclinane.2019.109695.
Yokoyama C, Mihara T, Kashiwagi S, Koga M, Goto T. Effects of intravenous dextrose on preventing postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis. PLoS One. 2020;15(4):e0231958. doi: https://doi.org/10.1371/journal.pone.0231958.
De Oliveira GS, Castro-Alves LJ, Chang R, Yaghmour E, McCarthy RJ. Systemic metoclopramide to prevent postoperative nausea and vomiting: A meta-analysis without Fujii’s studies. Br J Anaesth. 2012:688-97. doi: https://doi.org/10.1093/bja/aes325.
Ahn EJ, Kang H, Choi GJ, Baek CW, Jung YH, Woo YC. The effectiveness of midazolam for preventing postoperative nausea and vomiting: A systematic review and meta-analysis. Anesth Analg. 2016;122(3):664-76. doi: https://doi.org/10.1213/ANE.0000000000001062.
Grant MC, Kim J, Page AJ, Hobson D, Wick E, Wu CL. The effect of intravenous midazolam on postoperative nausea and vomiting: A meta-analysis. Anesth Analg. 2016;122(3):656-63. doi: https://doi.org/10.1213/ANE.0000000000000941.
Bhattacharjee D, Doleman B, Lund J, Williams J. Mirtazapine for postoperative nausea and vomiting: systematic review, meta-analysis, and trial sequential analysis. J PeriAnesthesia Nursing. 2019;34(4):680-90. doi: https://doi.org/10.1016/j.jopan.2018.11.006.
Barrons RW, Woods JA. Low-dose naloxone for prophylaxis of postoperative nausea and vomiting: A systematic review and meta-analysis. Pharmacotherapy. 2017;37(5):546-54, https://doi.org/10.1002/phar.1930.
Lee A, Done ML. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: A meta-analysis. Anesth Analg. 1999;88:1362-9.
Schaefer MS, Kranke P, Weibel S, Kreysing R, Kienbaum P. Total intravenous anaesthesia versus single-drug pharmacological antiemetic prophylaxis in adults: A systematic review and meta-analysis. Eur J Anaesthesiol. 2016;33(10):750-60. doi: https://doi.org/10.1097/EJA.0000000000000520.
Tramèr M, Moore A, McQuay H. Propofol anaesthesia and postoperative nausea and vomiting: Quantitative systematic review of randomized controlled studies. Br J Anaesth. 1997;78(3):247-55. doi: https://doi.org/10.1093/bja/78.3.247.
Pieper D, Antoine SL, Mathes T, Neugebauer EAM, Eikermann M. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol. 2014. doi: https://doi.org/10.1016/j.jclinepi.2013.11.007.
Baker WL, White CM, Cappelleri JC, Kluger J, Coleman CI. Understanding heterogeneity in meta-analysis: the role of meta-regression. Int J Clin Pract. 2009;63(10):1426-34. doi: https://doi.org/10.1111/j.1742-1241.2009.02168.x.
Ioannidis JPA, Trikalinos TA. The appropriateness of asymmetry tests for publication bias in meta-analyses: A large survey. CMAJ. 2007;176(8):1091-6. doi: https://doi.org/10.1503/cmaj.060410.
Downloads
Copyright (c) 2020 Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
