Dexamethasone for preventing postoperative nausea and vomiting after mastectomy

Area of Science:

• Anesthesiology and Perioperative Medicine
• Surgical Oncology
• Clinical Pharmacology

Background:

• Postoperative nausea and vomiting (PONV) is a frequent complication following mastectomy.
• Existing antiemetic therapies show limited efficacy in preventing PONV.
• Dexamethasone is explored as a potential prophylactic agent despite concerns regarding steroid side effects.

Purpose of the Study:

• To conduct a meta-analysis evaluating the efficacy of prophylactic dexamethasone in reducing PONV and postoperative pain after mastectomy.
• To synthesize evidence from randomized controlled trials (RCTs) on dexamethasone's impact on PONV incidence and severity.

Main Methods:

• A comprehensive literature search was performed across major databases (PubMed, Web of Science, EMBASE, MEDLINE, Cochrane) and Chinese periodicals until June 2019.
• Included studies were randomized controlled trials (RCTs) assessed for risk of bias using the Cochrane Handbook guidelines.
• Data analysis was performed using RevMan 5.3 software.

Main Results:

• Four studies involving 490 patients were included in the meta-analysis.
• Dexamethasone significantly reduced the incidence of PONV (RR=0.46, P=.0003), nausea (RR=0.26, P=.006), and vomiting (RR=0.15, P=.004) compared to placebo.
• A significant reduction in postoperative pain was observed at 1 hour (WMD=-1.40, P<.00001) but not at 24 hours (WMD=-0.56, P=.11).

Conclusions:

• Prophylactic dexamethasone is effective in decreasing the incidence of PONV and reducing early postoperative pain following mastectomy.
• Larger, high-quality studies are warranted to further elucidate the optimal timing of dexamethasone administration for managing PONV and pain.