title: Dexamethasone combined with other antiemetics versus single antiemetics for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: An updated systematic review and meta-analysis.
abstract: OBJECTIVE
  A systematic review and meta-analysis of published randomized controlled trials was performed to update the present evidence about the safety and efficacy of dexamethasone combined with other antiemetics versus single antiemetics for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy.
  
  
  METHODS
  A computer literature search of PubMed, Scopus, Web of Science and Embase was conducted to identify the relevant randomized controlled trials. In addition, a manual search of reference lists of the retrieved articles was conducted. Relevant outcomes were pooled as odds ratio (OR) by RevMan version 5.3 for windows.
  
  
  RESULTS
  Pooled data from 14 RCTs (1542 patients) favored dexamethasone combined with other antiemetics over single antiemetics as a prophylaxis against postoperative nausea and vomiting after laparoscopic cholecystectomy in the early postoperative period (OR = 0.39, 95% CI [0.27 to 0.54], p < 0.00001), late postoperative period (OR = 0.36, 95% CI [0.23 to 0.56], p < 0.00001), and overall postoperative period (OR = 0.34, 95% CI [0.23 to 0.51], p < 0.00001). Subsequently, rescue antiemetic usage was significantly lower in the combination group (OR = 0.25, 95% CI [0.16 to 0.41], p < 0.00001). Subgroup analysis showed that all combinations of dexamethasone and other antiemetics were superior to corresponding singel antiemetics except for the combination of dexamethasone and ramosetron which was not superior to ramosetron alone in all postoperative periods and the combination of dexamethasone and granisetron which was not superior to granisetron alone in the early postoperative period (OR = 0.26, 95% CI [0.07 to 1.01], p = 0.05). For all adverse events, there was no significant difference between the two groups.
  
  
  CONCLUSIONS
  Dexamethasone combined with other antiemetics provided better prophylaxis than single antiemetics against postoperative nausea and vomiting after laparoscopic cholecystectomy. The underlying mechanism of dexamethasone action and its optimal dose should be further investigated.
authors: Medical Research Group of Egypt, Cairo, Egypt; Student Research Unit, Zagazig University, Zagazig, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors: Kamal
authors: K
authors: Awad
authors: Medical Research Group of Egypt, Cairo, Egypt; Student Research Unit, Zagazig University, Zagazig, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt.
authors: Hussien
authors: H
authors: Ahmed
authors: Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Ain Shams University, Cairo, Egypt; NovaMed Medical Research Association, Cairo, Egypt. Electronic address: Abdelrahman.abushouk@med.asu.edu.eg.
authors: Abdelrahman Ibrahim
authors: AI
authors: Abushouk
authors: Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Tanta University, Tanta, Egypt.
authors: Safwat
authors: S
authors: Al Nahrawi
authors: Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Mansoura University, Mansoura, Egypt.
authors: Mohammed Yasser
authors: MY
authors: Elsherbeny
authors: Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
authors: Salma Muhammad
authors: SM
authors: Mustafa
authors: Medical Research Group of Egypt, Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
authors: Attia
authors: A
authors: Attia
mesh_terms: D000932:Antiemetics / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000627:therapeutic use; D017081:Cholecystectomy, Laparoscopic; D003907:Dexamethasone / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D017829:Granisetron / Q000627:therapeutic use; D006801:Humans; D007546:Isoquinolines / Q000627:therapeutic use; D008787:Metoclopramide / Q000627:therapeutic use; D017294:Ondansetron / Q000627:therapeutic use; D000077924:Palonosetron; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011812:Quinuclidines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
chemical_list: D000932:Antiemetics; D001562:Benzimidazoles; D003907:Dexamethasone; D017829:Granisetron; D007546:Isoquinolines; D008787:Metoclopramide; D017294:Ondansetron; D000077924:Palonosetron; D011812:Quinuclidines; C071315:ramosetron
keywords: Antiemetics; Laparoscopic cholecystectomy; Meta-analysis; Postoperative nausea and vomiting