Dexamethasone versus ondansetron in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: a meta-analysis of randomized controlled trials.
BACKGROUND
Dexamethasone is an antiemetic alternative to ondansetron. We aimed to compare the effects of dexamethasone and ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery.


METHODS
We searched PubMed, Embase, Medline and Cochrane Library (from inception to July 2014) for eligible studies. The primary outcome was the incidence of PONV during the first 24 h after surgery. The secondary outcomes included PONV in the early postoperative stage (0-6 h), PONV in the late postoperative stage (6-24 h), and the postoperative anti-emetics used at both stages. We calculated pooled risk ratios (RR) and 95 % CIs using random- and fixed-effects models.


RESULTS
Seven trials involving 608 patients were included in this meta-analysis, which found that dexamethasone had a comparable effectiveness in preventing PONV (RR, 0.91; 95 % CI, 0.73-1.13; P = 0.39) with that of ondansetron within 24 h of laparoscopic surgery, with no evidence of heterogeneity among the studies (I(2) = 0 %; P = 0.71). In the early postoperative stage (0-6 h), ondansetron was better at decreasing PONV than dexamethasone (RR, 1.71; 95 % CI, 1.05-2.77; P = 0.03), while in the late postoperative stage (6-24 h), dexamethasone was more effective in preventing PONV than ondansetron (RR, 0.51; 95 % CI, 0.27-0.93; P = 0.03). There was no significant difference in the postoperative anti-emetics used (RR, 0.90; 95 % CI, 0.67-1.19; P = 0.45).


CONCLUSIONS
Dexamethasone was as effective and as safe as ondansetron in preventing PONV. Dexamethasone should be encouraged as an alternative to ondansetron for preventing PONV in patients undergoing laparoscopic surgery.
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical College, Xuzhou, Jiangsu, China. wxxxzyxy2013@163.com.|Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou, Jiangsu, China. wxxxzyxy2013@163.com.
Xian-Xue
XX
Wang
Science & Education Division of the First People's Hospital of Changde City, Changde, Hunan, China. 303117131@qq.com.
Quan
Q
Zhou
Department of Anesthesiology of the First People's Hospital of Changde City, Changde, Hunan, China. pdbxzyxy2013@163.com.
Dao-Bo
DB
Pan
Department of Anesthesiology of the First People's Hospital of Changde City, Changde, Hunan, China. 278773201@qq.com.
Hui-Wei
HW
Deng
Department of Anesthesiology of the First People's Hospital of Changde City, Changde, Hunan, China. zag0736@163.com.
Ai-Guo
AG
Zhou
Department of Anesthesiology of the First People's Hospital of Changde City, Changde, Hunan, China. hfr0736@163.com.
Fu-Rong
FR
Huang
Department of Anesthesiology of the First People's Hospital of Changde City, Changde, Hunan, China. ghj0736@163.com.
Hua-Jing
HJ
Guo
D000932:Antiemetics / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use*; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D017294:Ondansetron / Q000627:therapeutic use*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D000932:Antiemetics; D017294:Ondansetron; D003907:Dexamethasone