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Prevention of vomiting after paediatric strabismus surgery: a systematic review using the numbers-needed-to-treat
Insights
Prophylactic antiemetic therapy in paediatric strabismus surgery shows limited proven benefits. Droperidol demonstrated some efficacy but carried risks, while metoclopramide offered minimal improvement, and propofol was ineffective and risky.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Postoperative nausea and vomiting (PONV) are common complications after pediatric strabismus surgery.
- Antiemetic prophylaxis is frequently administered, but its effectiveness and safety profile require thorough evaluation.
Purpose of the Study:
- To assess the efficacy and safety of antiemetic drugs for preventing early and late vomiting in pediatric strabismus surgery.
- To evaluate adverse effects associated with prophylactic antiemetic use.
Main Methods:
- Systematic review of randomized controlled studies.
- Evaluation of antiemetic effectiveness using the numbers-needed-to-treat (NNT) method.
- Analysis of data from 27 reports involving 2033 children.
Main Results:
- Without prophylaxis, early and late vomiting incidence was 54% and 59%, respectively.
- Droperidol (75 µg/kg) was the most effective documented regimen (NNT=4), with a low risk of extrapyramidal reactions (<1%) and minor adverse effects (16%).
- Metoclopramide showed a significant benefit only for early vomiting. Propofol was associated with oculocardiac reflex and lacked significant antiemetic effect.
Conclusions:
- The overall benefits of prophylactic antiemetic therapy in pediatric strabismus surgery are not definitively proven.
- Droperidol may be considered, but its use requires careful monitoring for adverse effects.
- Propofol should be avoided due to its adverse effects and lack of efficacy.
Abstract:
Randomized controlled studies were reviewed to assess the effectiveness and safety of antiemetics used for prophylaxis in paediatric strabismus surgery. Early and late vomiting (6 and 48 h after operation, respectively), and adverse effects were evaluated using the numbers-needed-to-treat method. In 27 reports with information on 2033 children, the mean incidence of early vomiting was 54% and of late vomiting 59%, without prophylaxis. Only three drugs were studied sufficiently for firm conclusions to be drawn. In the best documented regimen (droperidol 75 micrograms kg-1), four children have to be given the drug to prevent one vomiting; of the three others, one may vomit and two would not have vomited anyway; fewer than one child in 100 may have an extrapyramidal reaction and 16 may have minor adverse effects. Metoclopramide 0.15 and 0.25 mg kg-1 was significantly better than control only for early vomiting. Propofol had a high incidence of oculocardiac reflex without conferring any significant antiemetic effect: it should not be used. The benefits of prophylactic antiemetic therapy are not proven.