Comparison of Ondansetron and Dexamethasone for Prophylaxis of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Surgeries: A Meta-Analysis of Randomized Controlled Trials

Overview

Journal Anesthesiol Res Pract

Publisher Wiley

Specialty Anesthesiology

Date 2016 Apr 26

PMID 27110238

Citations 13

Authors

Souvik Maitra

Anirban Som

Dalim K Baidya

Sulagna Bhattacharjee

Affiliations

Soon will be listed here.

Abstract

Background. Postoperative nausea and vomiting (PONV) is a significant complication after laparoscopic surgeries. Ondansetron and dexamethasone are most commonly used drugs for PONV prophylaxis. Comparisons of these two drugs have not been systematically reviewed till date. Methods. PubMed, PubMed Central, and CENTRAL databases were searched with the following words: "dexamethasone," "ondansetron," "laparoscopy," and "PONV" to identify randomized trials that compared ondansetron and dexamethasone for PONV prophylaxis after laparoscopic surgeries. Results. Data of 592 patients from 7 RCTs have been included in this meta-analysis. Incidence of postoperative nausea at 4-6 h is significantly lower when dexamethasone was used instead of ondansetron (p = 0.04; OR 0.49, 95% CI 0.24-0.98, M-H fixed). Incidence of nausea is similar at 24 hours (p = 0.08, OR 0.71, 95% CI 0.48, 1.05; M-H fixed); vomiting is also similar at 4-6 h (p = 0.43, OR 1.27, 95% CI 0.70-2.27; M-H fixed) and also at 24 h (p = 0.46, OR 0.92, 95% CI 0.73, 1.16; M-H fixed). Conclusion. Dexamethasone is superior to ondansetron in preventing postoperative nausea after 4-6 h of laparoscopic surgeries. However, both the drugs are of equal efficacy in preventing postoperative vomiting up to 24 h after surgery. However, results should be interpreted with caution due to clinical heterogeneity in the included studies.

Citing Articles

Robotic Pediatric Urologic Surgery-Clinical Anesthetic Considerations: A Comprehensive Review.

Khater N, Swinney S, Fitz-Gerald J, Abdelrazek A, Domingue N, Shekoohi S Anesth Pain Med. 2024; 14(3):e146438.

PMID: 39416801 PMC: 11473995. DOI: 10.5812/aapm-146438.

Analysis of influencing factors and construction of prediction model for postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy: a single-center retrospective cohort study.

Liao B, Liao W, Wu X, Liu S, Li Y, Qin R BMC Anesthesiol. 2024; 24(1):131.

PMID: 38580903 PMC: 10996113. DOI: 10.1186/s12871-024-02502-z.

The Effectiveness of Ondansetron and Dexamethasone in Preventing Postoperative Nausea and Vomiting After Laparoscopic Cholecystectomy.

Qasemi F, Aini T, Ali W, Dost W, Rasully M, Anwari M Cureus. 2023; 15(4):e37419.

PMID: 37181978 PMC: 10174678. DOI: 10.7759/cureus.37419.

Prevention of postoperative nausea and vomiting after gynaecological day surgery under remimazolam general anesthesia: a randomized double-blind controlled study.

Yi F, Xiao H, Zhu T, Man Y, Ji F BMC Anesthesiol. 2022; 22(1):292.

PMID: 36109691 PMC: 9476338. DOI: 10.1186/s12871-022-01835-x.

A diagnostic workup and laparoscopic approach for median arcuate ligament syndrome.

Diab J, Diab V, Berney C ANZ J Surg. 2022; 92(7-8):1742-1747.

PMID: 35104014 PMC: 9545262. DOI: 10.1111/ans.17514.

References

Gautam B, Shrestha B, Lama P, Rai S . Antiemetic prophylaxis against postoperative nausea and vomiting with ondansetron-dexamethasone combination compared to ondansetron or dexamethasone alone for patients undergoing laparoscopic cholecystectomy. Kathmandu Univ Med J (KUMJ). 2010; 6(23):319-28. DOI: 10.3126/kumj.v6i3.1706. View

Yuksek M, Alici H, Erdem A, Cesur M . Comparison of prophylactic anti-emetic effects of ondansetron and dexamethasone in women undergoing day-case gynaecological laparoscopic surgery. J Int Med Res. 2004; 31(6):481-8. DOI: 10.1177/147323000303100603. View

Tang J, Wang B, White P, Watcha M, Qi J, Wender R . The effect of timing of ondansetron administration on its efficacy, cost-effectiveness, and cost-benefit as a prophylactic antiemetic in the ambulatory setting. Anesth Analg. 1998; 86(2):274-82. DOI: 10.1097/00000539-199802000-00010. View

Gupta P, Khanna J, Mitramustafi A, Bhartia V . Role of pre-operative dexamethasone as prophylaxis for postoperative nausea and vomiting in laparoscopic surgery. J Minim Access Surg. 2010; 2(1):12-5. PMC: 2997215. DOI: 10.4103/0972-9941.25671. View

Wang J, Ho S, Uen Y, Lin M, Chen K, Tzeng J . Small-dose dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy: a comparison of tropisetron with saline. Anesth Analg. 2002; 95(1):229-32, table of contents. DOI: 10.1097/00000539-200207000-00042. View

Mendes M, Monteiro R, Martins F . [Prophylaxis of postoperative nausea and vomiting in morbidly obese patients undergoing laparoscopic gastroplasties: a comparative study among three methods]. Rev Bras Anestesiol. 2009; 59(5):570-6. DOI: 10.1016/s0034-7094(09)70081-9. View

Macario A, Weinger M, Carney S, Kim A . Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999; 89(3):652-8. DOI: 10.1097/00000539-199909000-00022. View

Henzi I, Walder B, Tramer M . Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg. 2000; 90(1):186-94. DOI: 10.1097/00000539-200001000-00038. View

Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M . Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015; 350:g7647. DOI: 10.1136/bmj.g7647. View

10.

Erhan Y, Erhan E, Aydede H, Yumus O, Yentur A . Ondansetron, granisetron, and dexamethasone compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy : A randomized placebo-controlled study. Surg Endosc. 2007; 22(6):1487-92. DOI: 10.1007/s00464-007-9656-3. View

11.

Wang J, Ho S, Tzeng J, Tang C . The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Anesth Analg. 2000; 91(1):136-9. DOI: 10.1097/00000539-200007000-00025. View

12.

Bisgaard T, Klarskov B, Kehlet H, Rosenberg J . Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial. Ann Surg. 2003; 238(5):651-60. PMC: 1356141. DOI: 10.1097/01.sla.0000094390.82352.cb. View

13.

Alghanem S, Massad I, Rashed E, Abu-Ali H, Daradkeh S . Optimization of anesthesia antiemetic measures versus combination therapy using dexamethasone or ondansetron for the prevention of postoperative nausea and vomiting. Surg Endosc. 2009; 24(2):353-8. DOI: 10.1007/s00464-009-0567-3. View

14.

Dsouza N, Swami M, Bhagwat S . Comparative study of dexamethasone and ondansetron for prophylaxis of postoperative nausea and vomiting in laparoscopic gynecologic surgery. Int J Gynaecol Obstet. 2011; 113(2):124-7. DOI: 10.1016/j.ijgo.2010.11.022. View

15.

Leksowski K, Peryga P, Szyca R . Ondansetron, metoclopramid, dexamethason, and their combinations compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a prospective randomized study. Surg Endosc. 2006; 20(6):878-82. DOI: 10.1007/s00464-005-0622-7. View

16.

Hozo S, Djulbegovic B, Hozo I . Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5:13. PMC: 1097734. DOI: 10.1186/1471-2288-5-13. View

17.

Thune A, Appelgren L, Haglind E . Prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. A prospective randomized study of metoclopramide and transdermal hyoscine. Eur J Surg. 1995; 161(4):265-8. View

18.

Subramaniam B, Madan R, Sadhasivam S, Sennaraj B, Tamilselvan P, Rajeshwari S . Dexamethasone is a cost-effective alternative to ondansetron in preventing PONV after paediatric strabismus repair. Br J Anaesth. 2001; 86(1):84-9. DOI: 10.1093/bja/86.1.84. View

19.

Watcha M, White P . Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 1992; 77(1):162-84. DOI: 10.1097/00000542-199207000-00023. View

20.

Myles P, Williams D, Hendrata M, Anderson H, Weeks A . Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000; 84(1):6-10. DOI: 10.1093/oxfordjournals.bja.a013383. View