WITHDRAWN: Drugs for preventing postoperative nausea and vomiting

Area of Science:

• Anesthesiology and Pharmacology
• Evidence-Based Medicine

Background:

• Postoperative nausea and vomiting (PONV) affects a significant number of surgical patients.
• While various drugs can prevent PONV, their comparative effectiveness and safety profiles are not well-established.
• A comprehensive systematic review is needed to compare these antiemetic agents.

Purpose of the Study:

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

Main Methods:

• Conducted a systematic search of multiple electronic databases including CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, SIGLE, ISI WOS, LILAC, and INGENTA.
• Included randomized controlled trials comparing antiemetic drugs against placebo or other drugs, or comparing different dosages and administration timings.
• Two independent reviewers assessed trial quality and extracted outcome data for nausea and vomiting prevention and side effects.

Main Results:

• Included 737 studies with 103,237 participants.
• Eight drugs demonstrated efficacy in preventing PONV compared to placebo: droperidol, metoclopramide, ondansetron, tropisetron, dolasetron, dexamethasone, cyclizine, and granisetron.
• Evidence for significant differences among these drugs is limited by publication bias. Relative risks (RR) versus placebo ranged from 0.60 to 0.80. Sedation was noted with droperidol (RR 1.32) and headache with ondansetron (RR 1.16).

Conclusions:

• Antiemetic drugs offer a benefit, reducing PONV incidence, but are less effective when baseline PONV rates are low.
• Mild side effects such as sedation and headache are reported in a small percentage of patients (1-5%).
• Future research should prioritize investigating severe, rare side effects of antiemetics, rather than further comparing the efficacy of different drugs.