Prevention of vomiting after paediatric strabismus surgery: a systematic review using the numbers-needed-to-treat method.
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.
Tramèr
M
M
Oxford Pain Relief Unit, Churchill Hospital, Headington.
Moore
A
A
McQuay
H
H
D000932:Antiemetics / Q000627:therapeutic use*; D002648:Child; D004329:Droperidol / Q000627:therapeutic use; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D015742:Propofol / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013285:Strabismus / Q000601:surgery*; D014839:Vomiting / Q000517:prevention & control*
D000932:Antiemetics; D004329:Droperidol; D015742:Propofol