title: Dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing thyroidectomy: meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Postoperative nausea and vomiting (PONV) is a common complication after thyroidectomy. Steroids effectively reduce nausea, pain, and inflammation; therefore, preoperative administration of steroids ought to improve these surgical outcomes.
  
  
  METHODS
  We conducted a systematic review of randomized controlled trials (RCTs) that compared preoperative single-dose administration of dexamethasone with no dexamethasone in patients undergoing thyroidectomy. The primary outcome was occurrence of PONV within 24 h, and the secondary outcomes were pain, use of analgesics, and steroid-related complications.
  
  
  RESULTS
  Five RCTs were included with a total of 497 patients. A statistically and clinically significant difference in the incidence of PONV was found in favor of dexamethasone [relative risk (RR) 0.38; 95% confidence interval (CI) 0.30-0.49). The visual analog pain score was significantly diminished (weighted mean difference, WMD)-1.50; 95% CI-2.54 to -0.46) at 24 h. The incidence of analgesics use was also reduced (RR 0.61; 95% CI 0.41-0.90) in the dexamethasone group. No steroid-related complications were noted.
  
  
  CONCLUSIONS
  A single preoperative administration of dexamethasone reduced the incidence of PONV and analgesic requirements in patients undergoing thyroidectomy. Prophylactic use of steroids for patients undergoing thyroidectomy is safe and should be considered for routine clinical practice.
authors.affiliation: Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, 252 Wuxing Street, Taipei 11031, Taiwan.
authors.forename: Chia-Che
authors.initials: CC
authors.lastname: Chen
authors.forename: Fahad Javaid
authors.initials: FJ
authors.lastname: Siddiqui
authors.forename: Ta-Liang
authors.initials: TL
authors.lastname: Chen
authors.forename: Edwin Shih-Yen
authors.initials: ES
authors.lastname: Chan
authors.forename: Ka-Wai
authors.initials: KW
authors.lastname: Tam
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D006801:Humans; D010149:Postoperative Pain / Q000188:drug therapy; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D013965:Thyroidectomy; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000932:Antiemetics; D003907:Dexamethasone
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