Dataset Information

Pharmacological interventions for preventing postoperative nausea and vomiting in adult patients undergoing ambulatory surgery: Protocol for a systematic review and network meta-analysis.

ABSTRACT:

Background

We aimed to conduct a systematic review and network meta-analysis (NMA) of published studies to comprehensively compare and rank the efficacy and safety of pharmacological interventions for preventing nausea and vomiting after ambulatory surgery.

Methods

A systematic and comprehensive search will be performed using the MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar databases, beginning from their inceptions to July and August 2019. Only randomized clinical trials on the efficacy and safety of pharmacologic interventions for preventing nausea and vomiting after ambulatory surgery will be included.The primary endpoints will be the incidences of postoperative nausea (PON), postoperative vomiting (POV), and postoperative nausea and vomiting (PONV) in the following recovery phases: before discharge (recovery phase I and II), after discharge but within 24 hours following surgery, and after discharge, after the initial 24-hour postoperative period.The incidences of delayed post-discharge nausea, post-discharge vomiting, and post-discharge nausea and vomiting, which occur after the initial 24-hour postoperative period, severities of PON, POV, and PONV, use of rescue antiemetics, and the incidence of complete response, as well as safety issues, including complications, such as headache, dizziness, and drowsiness, will be also assessed.We will conduct both pairwise meta-analysis and NMA. We will use surface under the cumulative ranking curve values and rankograms to present the hierarchy of the pharmacologic interventions. A comparison-adjusted funnel plot will be used to assess the presence of small-study effects. The quality of the studies included will be assessed using the risk of bias tool 2.0. All statistical analyses will be performed using Stata SE, version 15.0 (StataCorp, College Station, TX).

Results

The results of this systematic review and NMA will be published in a peer-reviewed journal.

Conclusion

This systematic review and NMA will provide comprehensive and convincing evidence summarizing the efficacy and safety of pharmacological interventions for preventing nausea and vomiting after ambulatory surgery.

Trial registration number

CRD42018103068.

SUBMITTER: Choi GJ

PROVIDER: S-EPMC6708945 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Postoperative nausea and vomiting (PONV) is one of the most common adverse outcomes after strabismus surgery. The primary outcome of this prospective, randomized, double-blind study was to compare the incidences of nausea or vomiting, and patient satisfaction of ondansetron and ramosetron after strabismus surgery under general anesthesia. The secondary outcome was to investigate whether the number of involved extraocular muscles (EOMs) in strabismus surgery was related to PONV.One hundred and five patients (aged 18-60 years) undergoing strabismus surgery were allocated randomly to one of the three groups: placebo, ondansetron, or ramosetron. Patients received 2 ml placebo, 4 mg ondansetron, or 0.3 mg ramosetron at the end of surgery. Each of the three groups was subdivided into two subgroups according to the number of EOMs involved in the surgery: subgroup S, single-muscle correction; subgroup M, multiple-muscle correction. The incidences of nausea or vomiting, and patient satisfaction at 2, 24 and 48 h after surgery were analyzed as primary outcome. With regard to subgroups S and M in the placebo, ondansetron and ramosetron groups, incidences of nausea or vomiting, and patient satisfaction at 2, 24 and 48 h after surgery were analyzed as seconadary outcome.The incidence of nausea was significantly lower in the ramosetron group at 2 h (9.4 %) than in the placebo (45.2 %) and ondansetron (34.7 %) groups (P < 0.05). The incidence of nausea was also significantly lower in the ramosetron group at 24 h than in the other groups (P < 0.05). Patients in the ramosetron group were more satisfied at 2 h (8.11 ± 0.98) and 24 h (8.50 ± 0.67) after surgery than those in the other groups (P < 0.05). With regard to subgroups S and M in the placebo, ondansetron and ramosetron groups, there were no significant differences in either the incidence of nausea or patient satisfaction.Ramosetron has superior antiemetic activity to ondansetron in adult strabismus surgery patients. The number of EOMs involved in strabismus surgery was not related to the incidence of PONV.Clinical Research Information Service (CRiS) Identifier: KCT0000688 . Date of registration: 27 February 2013.

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