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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.
Int J Surg. 2016 Dec; 36(Pt A):152-163.IJ

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.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Awad K
Medical Research Group of Egypt, Cairo, Egypt; Student Research Unit, Zagazig University, Zagazig, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Ahmed H
Medical Research Group of Egypt, Cairo, Egypt; Student Research Unit, Zagazig University, Zagazig, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Abushouk AI
Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Ain Shams University, Cairo, Egypt; NovaMed Medical Research Association, Cairo, Egypt. Electronic address: Abdelrahman.abushouk@med.asu.edu.eg.
Al Nahrawi S
Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Tanta University, Tanta, Egypt.
Elsherbeny MY
Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Mustafa SM
Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Attia A
Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

MeSH

AntiemeticsBenzimidazolesCholecystectomy, LaparoscopicDexamethasoneDrug Therapy, CombinationGranisetronHumansIsoquinolinesMetoclopramideOndansetronPalonosetronPostoperative Nausea and VomitingQuinuclidinesRandomized Controlled Trials as Topic

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

27793640

Citation

Awad, Kamal, et al. "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." International Journal of Surgery (London, England), vol. 36, no. Pt A, 2016, pp. 152-163.
Awad K, Ahmed H, Abushouk AI, et al. 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. Int J Surg. 2016;36(Pt A):152-163.
Awad, K., Ahmed, H., Abushouk, A. I., Al Nahrawi, S., Elsherbeny, M. Y., Mustafa, S. M., & Attia, A. (2016). 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. International Journal of Surgery (London, England), 36(Pt A), 152-163. https://doi.org/10.1016/j.ijsu.2016.10.034
Awad K, et al. 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. Int J Surg. 2016;36(Pt A):152-163. PubMed PMID: 27793640.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Awad,Kamal, AU - Ahmed,Hussien, AU - Abushouk,Abdelrahman Ibrahim, AU - Al Nahrawi,Safwat, AU - Elsherbeny,Mohammed Yasser, AU - Mustafa,Salma Muhammad, AU - Attia,Attia, Y1 - 2016/10/25/ PY - 2016/09/26/received PY - 2016/10/21/accepted PY - 2016/10/31/pubmed PY - 2017/1/25/medline PY - 2016/11/7/entrez KW - Antiemetics KW - Laparoscopic cholecystectomy KW - Meta-analysis KW - Postoperative nausea and vomiting SP - 152 EP - 163 JF - International journal of surgery (London, England) JO - Int J Surg VL - 36 IS - Pt A N2 - 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. SN - 1743-9159 UR - https://www.unboundmedicine.com/medline/citation/27793640/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_ DB - PRIME DP - Unbound Medicine ER -