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Drugs for preventing postoperative nausea and vomiting in adults after general anesthesia: An abridged Cochrane network meta-analysis.
J Evid Based Med. 2021 Sep; 14(3):188-197.JE

Abstract

OBJECTIVE

In this abridged version of the recently published Cochrane review on antiemetic drugs, we summarize its most important findings and discuss the challenges and the time needed to prepare what is now the largest Cochrane review with network meta-analysis in terms of the number of included studies and pages in its full printed form.

METHODS

We conducted a systematic review with network meta-analyses to compare and rank single antiemetic drugs and their combinations belonging to 5HT₃-, D₂-, NK₁-receptor antagonists, corticosteroids, antihistamines, and anticholinergics used to prevent postoperative nausea and vomiting in adults after general anesthesia.

RESULTS

585 studies (97 516 participants) testing 44 single drugs and 51 drug combinations were included. The studies' overall risk of bias was assessed as low in only 27% of the studies. In 282 studies, 29 out of 36 drug combinations and 10 out of 28 single drugs lowered the risk of vomiting at least 20% compared to placebo. In the ranking of treatments, combinations of drugs were generally more effective than single drugs. Single NK1 receptor antagonists were as effective as other drug combinations. Of the 10 effective single drugs, certainty of evidence was high for aprepitant, ramosetron, granisetron, dexamethasone, and ondansetron, while moderate for fosaprepitant and droperidol. For serious adverse events (SAEs), any adverse event (AE), and drug-class specific side effects evidence for intervention effects was mostly not convincing.

CONCLUSIONS

There is high or moderate evidence for at least seven single drugs preventing postoperative vomiting. However, there is still considerable lack of evidence regarding safety aspects that does warrant investigation.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Weibel S
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany.
Pace NL
Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA.
Schaefer MS
Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. Department of Anaesthesiology, University Hospital Duesseldorf, Duesseldorf, Germany.
Raj D
Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Queen Elizabeth University Hospital, Glasgow, UK.
Schlesinger T
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany.
Meybohm P
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany.
Kienbaum P
Department of Anaesthesiology, University Hospital Duesseldorf, Duesseldorf, Germany.
Eberhart LHJ
Department of Anaesthesiology & Intensive Care Medicine, Philipps-University Marburg, Marburg, Germany.
Kranke P
Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany.

MeSH

AdultAnesthesia, GeneralAntiemeticsHumansNetwork Meta-AnalysisPharmaceutical PreparationsPostoperative Nausea and Vomiting

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

34043870

Citation

Weibel, Stephanie, et al. "Drugs for Preventing Postoperative Nausea and Vomiting in Adults After General Anesthesia: an Abridged Cochrane Network Meta-analysis." Journal of Evidence-based Medicine, vol. 14, no. 3, 2021, pp. 188-197.
Weibel S, Pace NL, Schaefer MS, et al. Drugs for preventing postoperative nausea and vomiting in adults after general anesthesia: An abridged Cochrane network meta-analysis. J Evid Based Med. 2021;14(3):188-197.
Weibel, S., Pace, N. L., Schaefer, M. S., Raj, D., Schlesinger, T., Meybohm, P., Kienbaum, P., Eberhart, L. H. J., & Kranke, P. (2021). Drugs for preventing postoperative nausea and vomiting in adults after general anesthesia: An abridged Cochrane network meta-analysis. Journal of Evidence-based Medicine, 14(3), 188-197. https://doi.org/10.1111/jebm.12429
Weibel S, et al. Drugs for Preventing Postoperative Nausea and Vomiting in Adults After General Anesthesia: an Abridged Cochrane Network Meta-analysis. J Evid Based Med. 2021;14(3):188-197. PubMed PMID: 34043870.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Drugs for preventing postoperative nausea and vomiting in adults after general anesthesia: An abridged Cochrane network meta-analysis. AU - Weibel,Stephanie, AU - Pace,Nathan L, AU - Schaefer,Maximilian S, AU - Raj,Diana, AU - Schlesinger,Tobias, AU - Meybohm,Patrick, AU - Kienbaum,Peter, AU - Eberhart,Leopold H J, AU - Kranke,Peter, Y1 - 2021/05/27/ PY - 2021/02/08/revised PY - 2020/12/18/received PY - 2021/04/10/accepted PY - 2021/5/28/pubmed PY - 2021/10/29/medline PY - 2021/5/27/entrez KW - antiemetics KW - network meta-analysis KW - postoperative nausea and vomiting KW - systematic review KW - vomiting SP - 188 EP - 197 JF - Journal of evidence-based medicine JO - J Evid Based Med VL - 14 IS - 3 N2 - OBJECTIVE: In this abridged version of the recently published Cochrane review on antiemetic drugs, we summarize its most important findings and discuss the challenges and the time needed to prepare what is now the largest Cochrane review with network meta-analysis in terms of the number of included studies and pages in its full printed form. METHODS: We conducted a systematic review with network meta-analyses to compare and rank single antiemetic drugs and their combinations belonging to 5HT₃-, D₂-, NK₁-receptor antagonists, corticosteroids, antihistamines, and anticholinergics used to prevent postoperative nausea and vomiting in adults after general anesthesia. RESULTS: 585 studies (97 516 participants) testing 44 single drugs and 51 drug combinations were included. The studies' overall risk of bias was assessed as low in only 27% of the studies. In 282 studies, 29 out of 36 drug combinations and 10 out of 28 single drugs lowered the risk of vomiting at least 20% compared to placebo. In the ranking of treatments, combinations of drugs were generally more effective than single drugs. Single NK1 receptor antagonists were as effective as other drug combinations. Of the 10 effective single drugs, certainty of evidence was high for aprepitant, ramosetron, granisetron, dexamethasone, and ondansetron, while moderate for fosaprepitant and droperidol. For serious adverse events (SAEs), any adverse event (AE), and drug-class specific side effects evidence for intervention effects was mostly not convincing. CONCLUSIONS: There is high or moderate evidence for at least seven single drugs preventing postoperative vomiting. However, there is still considerable lack of evidence regarding safety aspects that does warrant investigation. SN - 1756-5391 UR - https://www.unboundmedicine.com/medline/citation/34043870/Drugs_for_preventing_postoperative_nausea_and_vomiting_in_adults_after_general_anesthesia:_An_abridged_Cochrane_network_meta_analysis_ DB - PRIME DP - Unbound Medicine ER -