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The efficacy of the 5-HT3 receptor antagonists combined with droperidol for PONV prophylaxis is similar to their combination with dexamethasone. A meta-analysis of randomized controlled trials

  • Ashraf S. Habib
  • Habib E. El-Moalem
  • Tong J. GanEmail author
General Anesthesia

Abstract

Purpose

The aim of this quantitative systematic review is to compare the efficacy and side effects of combining one of the 5-HT3 receptor antagonists (5-HT) with droperidol or dexamethasone for postoperative nausea and vomiting (PONV) prophylaxis.

Methods

We performed a systematic search (Medline, Embase, and the Cochrane Library) for randomized controlled trials that compared the antiemetic efficacy of combining one of the 5-HT with droperidol or dexamethasone vs 5-HT alone. Relevant end-points were prevention of early (0 to 6 hr), and overall (0 to 24 hr) PONY and side effects. The articles that could meet the inclusion criteria were scored for inclusion and methodological validity using the three-item, five-point, Oxford-scale. Relative risk and numbers needed-to-treat with 95% confidence intervals were calculated for each combination vs 5-HT alone. The two combinations were then indirectly compared. A random effects model was used.

Results

We considered 41 trials for analysis but subsequently excluded eight. Thirty-three trials with data from 3,447 patients were analyzed. Except for early nausea with the 5-HT plus droperidol, both combinations were significantly more effective than 5-HT in preventing early and overall PONV There was no difference in antiemetic efficacy between the two combinations. The incidence of commonly reported side effects was also similar in the two combination groups.

Conclusion

We conclude that there is no statistically significant difference in antiemetic efficacy or side effects profile when one of the 5-HT is combined with either droperidol or dexamethasone and that both combination regimens are significantly more effective than 5-HT alone.

Keywords

Laparoscopic Cholecystectomy Ondansetron Granisetron Droperidol Postoperative Nausea 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

L’efficacité de la combinaison des antagonistes des récepteurs 5-HT3 et du dropéridol ou de la dexaméthasone est similaire pour prévenir les NVPO. Une méta-analyse d’essais randomisés et contrôlés

Résumé

Objectif

Notre revue systématique quantitative visait à comparer l’efficacité et les effets secondaires de la combinaison de l’un des antagonistes des récepteurs 5-HT3 (5-HT) avec le dropéridol ou la dexaméthasone pour prévenir les nausées et vomissements postopératoires (NVPO).

Méthode

Nous avons réalisé une recherche systématique (Medline, Embase et Cochrane Library) des essais randomisés et contrôlés où on compare l’efficacité antiémétique de la combinaison de l’un des 5-HT avec le dropéridol ou la dexaméthasone vs le 5-HT employé seul. Les paramètres pertinents étaient la prévention des NVPO précoces (0 à 6 h) et globaux (0 à 24 h), et les effets secondaires. Les articles répondant aux critères d’inclusion ont été classés pour leur validité d’inclusion et de méthodologie grâce à l’échelle Oxford de trois éléments en cinq points. Le risque relatif et les nombres nécessaires à traiter selon un intervalle de confiance de 95 % ont été calculés pour chaque combinaison vs le 5-HT seul. Les deux combinaisons ont été ensuite comparées indirectement. Un modèle à effets aléatoires a été utilisé.

Résultats

Sur les 41 essais retenus pour l’analyse, huit ont été exclus et 33, comprenant les données sur 3 441 patients, ont donc été analysés. Mis à part les nausées précoces observées avec le 5-HT combiné au dropéridol, les deux combinaisons ont été significativement plus efficaces que le 5-HT seul pour prévenir les NVPO précoces et l’ensemble des NVPO. Les deux combinaisons ont présenté une efficacité antiémétique et des effets secondaires habituels similaires.

Conclusion

Il n’y a pas de différence statistiquement significative d’efficacité antiémétique ou d’effets secondaires quand on combine un 5-HT avec le dropéridol ou la dexaméthasone et les deux combinaisons sont significativement plus efficaces que le 5-HT seul.

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Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  • Ashraf S. Habib
    • 1
  • Habib E. El-Moalem
    • 1
  • Tong J. Gan
    • 1
    Email author
  1. 1.Department of AnesthesiologyDuke University Medical CenterDurhamUSA

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