Effect of stellate ganglion block on postoperative nausea and vomiting after general anesthesia: A meta-analysis

ObjectiveTo identify the effect of stellate ganglion block on the incidence of postoperative nausea and vomiting.MethodsWe systematically searched electronic databases for published randomized controlled trials comparing stellate ganglion block with placebo for reducing postoperative nausea and vomiting. The primary outcome was the incidence of postoperative nausea and vomiting after general anesthesia. Meta-regression analysis was performed to investigate potential sources of heterogeneity. Trial sequential analysis was also carried out to calculate the required information size.ResultsIn total, 16 randomized controlled trials including 1385 patients were included in the study. Stellate ganglion block significantly reduced the incidence of postoperative nausea and vomiting (relative risk, 0.59; 95% confidence interval, 0.49-0.70; P < 0.0001). Our meta-regression analysis confirmed that the significant correlation between stellate ganglion block and reduced postoperative nausea and vomiting risk remained robust and was not significantly influenced by study-level characteristics, including prophylactic antiemetic use, surgical technique, postoperative analgesia, female proportion, age, opioid administration, and inhalation anesthesia. In addition, trial sequential analysis indicated that the Z curve for stellate ganglion block not only crossed the conventional boundary but also the trial sequential analysis boundary for benefit.ConclusionThis meta-analysis suggested an association of stellate ganglion block with a decreased incidence of postoperative nausea and vomiting after general anesthesia. Trial sequential analysis showed that further studies are unlikely to alter the conclusions regarding the incidence of postoperative nausea and vomiting.PROSPERO registration number: CRD42024504829.