Drugs for preventing postoperative nausea and vomiting.

Area of Science:

• Anesthesiology and Pharmacology
• Clinical Medicine

Background:

• Postoperative nausea and vomiting (PONV) is a common complication following surgery.
• While various drugs can prevent PONV, their comparative efficacies and side effect profiles are not well-established in a single systematic review.

Purpose of the Study:

• To systematically review and assess the efficacy of drugs in preventing postoperative nausea and vomiting.
• To evaluate the incidence and types of side effects associated with these antiemetic drugs.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, SIGLE, ISI WOS, LILAC, INGENTA) up to May 2004.
• Included were 737 randomized controlled trials (RCTs) involving 103,237 participants.
• Data on PONV outcomes and side effects were independently extracted and analyzed.

Main Results:

• Eight drugs demonstrated efficacy in preventing PONV compared to placebo: droperidol, metoclopramide, ondansetron, tropisetron, dolasetron, dexamethasone, cyclizine, and granisetron.
• Publication bias limits the reliability of direct drug comparisons.
• Evidence for side effects was limited, with droperidol associated with sedation (RR 1.32) and headache with ondansetron (RR 1.16).

Conclusions:

• Antiemetic drugs offer benefit to a minority of patients; for instance, out of 100 patients with PONV, only 28 may benefit.
• Mild side effects, such as sedation or headache, occur in 1-5% of patients.
• Future research should investigate severe, rare side effects of antiemetics, as comparative efficacy between drugs is not a priority.