Effect of prophylactic dexamethasone on nausea and vomiting after laparoscopic gynecological operation: meta-analysis.

BACKGROUND Sex of female and laraproscopic surgery are both risk factors related to postoperative nausea and vomiting, and dexamethasone is used as anti-emetic in some operations. A meta-analysis of randomized trials was performed to determine the effect of prophylactic dexamethasone administration on postoperative nausea and vomiting, pain and complications in patients undergoing laparoscopic gynecological operation. METHODS A systematic literature search was conducted to identify all randomized clinical trials. The primary outcome was the incidence and severity of postoperative nausea and vomiting. The secondary outcomes include postoperative pain and complications. RESULTS Totally 1801 patients were enrolled in 11 eligible randomized trials comparing effect of prophylactic dexamethasone administration on postoperative nausea and vomiting with placebo. The pooled incidence of nausea, vomiting, nausea and vomiting, and rescue anti-emetic was significantly lower in dexamethasone group than placebo group during post-anesthesia care unit (10.5% vs. 18.2%, OR 0.51, 95% CI 0.31-0.84; 6.5% vs. 17.1%, OR 0.31, 95% CI 0.17-0.56; 17.0% vs. 35.4%, OR 0.33, 95% CI 0.21-0.50; 6.7% vs. 23.3%, OR 0.22, 95% CI 0.10-0.49, P < 0.00001) and within the first postoperative 24 hours (25.2% vs. 40.3%, OR 0.46, 95% CI 0.32-0.66; 14.4% vs 36.6%, OR 0.27, 95% CI 0.19-0.40; 33.0% vs. 69.0%, OR 0.18, 95% CI 0.13-0.26; 21.0% vs 51.1%, OR 0.26, 95% CI 0.16-0.41, P < 0.00001). No significant difference was found about the incidence of rescue analgesia between dexamethasone group and placebo group (48.5% vs 56.4%, OR 0.68, 95% CI 0.40-1.18, P = 0.17). CONCLUSION Prophylactic dexamethasone administration decreases the incidence of nausea and vomiting after laparoscopic gynecological operations during post-anesthesia care unit and within the first postoperative 24 hours. (286 words) Postoperative nausea and vomiting are the most common complications after anesthesia and surgery, and both sex of female and type of laparoscopic operation are risk factors. It is certain of a remarkably high incidence after laparoscopic gynecological surgery, which is reported as nearly 70% within the first postoperative 24 hours. It is very important to find an effective treatment to alleviate postoperative nausea and vomiting.