Dexamethasone for antiemesis in laparoscopic gynecologic surgery: a systematic review and meta-analysis

To estimate the beneficial and harmful effects of dexamethasone for prevention of postoperative nausea and vomiting in women undergoing laparoscopic gynecologic surgery.

We searched the following bibliographic databases: MEDLINE (from 1946 to January 2012), Embase (from 1980 to 2012 week 3), the Cochrane Central Register of Controlled Trials (from inception to January 2012), and ISI Web of Knowledge (from 1950 to January 2012). We also screened trial registries, reference lists of retrieved studies, and other sources of unpublished literature.

Two reviewers screened in duplicate and independently searched results for inclusion. We included randomized controlled trials (RCTs) comparing dexamethasone with a placebo in patients undergoing laparoscopic gynecologic surgery.

Two reviewers completed data extraction and assessed trials for bias in duplicate and independently. We used the Grading of Recommendations Assessment, Development, and Evaluation methodology to assess the quality of evidence across studies at the outcome level. A total of 13 RCTs with 1,695 patients met inclusion criteria. Data were pooled based on the random-effects model. The use of prophylactic dexamethasone significantly decreases the incidence of postoperative nausea (relative risk [RR] 0.56, 95% confidence interval [CI] 0.45-0.71), postoperative vomiting (RR 0.35, 95% CI 0.25-0.48), the need for rescue antiemetics (RR 0.39, 95% CI 0.29-0.52), and time to meet discharge criteria (mean 28.5 minutes, 95% CI 24.6-32.4). The estimated number needed to treat to prevent nausea in one patient was eight (95% CI 5-13), whereas that for vomiting was five (95% CI 4-6). There was no observed increase in adverse events. The quality of the evidence ranged from very low to moderate.

This systematic review provides evidence that dexamethasone decreases the incidence of postoperative nausea and vomiting after laparoscopic gynecologic surgery, with no observed increase in side effects.