title: 5HT3 antagonists for prophylaxis of postoperative nausea and vomiting in breast surgery: a meta-analysis.
abstract: BACKGROUND
  Postoperative nausea and vomiting (PONV) are distressing adverse events following breast cancer surgery with an incidence of up to 80%. 5HT 3 antagonists are commonly employed as drugs of first choice for PONV although there is no clear evidence favoring one pharmacological approach over another.
  
  
  OBJECTIVE
  The objective of this meta-analysis is to compare the efficacy of 5HT 3 antagonists against all non-5HT 3 antagonism-based pharmacological approaches as a preemptive strategy for PONV in women undergoing breast surgery.
  
  
  METHODS
  Meta-analysis of Randomized Controlled Trials.
  
  
  METHODS
  Literature search was conducted through PUBMED, reference lists, and Cochrane Central Register of Controlled Trials till June 2010 to identify eligible studies. Trials comparing 5-HT 3 antagonists with placebo or active controls for prophylaxis against PONV in women undergoing breast surgery were included. Two reviewers extracted the data independently. Methodological quality of each trial was assessed using Jadad score.
  
  
  RESULTS
  Nineteen trials were included. All trials were of good methodological quality (Jadad score >3). 5HT 3 antagonists were found superior to placebo [Odds ratio (OR)=0.18 (0.13-0.26)] or active controls [OR=0.65 (0.47-0.91)] in the prevention of PONV. 5HT 3 antagonists were also superior to placebo in preventing nausea alone [OR=0.51 (0.34-0.76)], vomiting [OR=0.31 (0.20-0.47)] and the use of rescue antiemetics [OR=0.18 (0.11-0.28)]. No significant difference was observed in the use of rescue antiemetics as compared to active controls [0.59 (0.19 to 1.86)].
  
  
  CONCLUSIONS
  5HT 3 antagonists are superior to other pharmacological interventions for the prevention of PONV in patients undergoing breast surgery under general anesthesia.
authors.affiliation: Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India.
authors.forename: A K
authors.initials: AK
authors.lastname: Singhal
authors.forename: S
authors.initials: S
authors.lastname: Kannan
authors.forename: V S
authors.initials: VS
authors.lastname: Gota
mesh_terms: D000758:Anesthesia / Q000009:adverse effects; D000932:Antiemetics / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D058831:Serotonin 5-HT3 Receptor Antagonists / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000932:Antiemetics; D058831:Serotonin 5-HT3 Receptor Antagonists