Anti-emetic Drugs for Prophylaxis of Postoperative Nausea and Vomiting After Craniotomy: An Updated Systematic Review and Network Meta-Analysis

Abstract

Background: There is uncertainty about the effect of antiemetic drugs (AED) for the prophylaxis of postoperative nausea and vomiting (PONV) after craniotomy. In this study, we assessed the effectiveness and safety of AED for PONV. Methods and Findings: We searched online databases including the Cochrane Library, PubMed, Wiley, Elsevier Science Direct, Ovid LWW, and Springer for publications from 1985 to June 2018. Adults undergoing craniotomy with the prophylactic use of at least one AED were included. The primary outcomes were the incidence of postoperative nausea (PON) and postoperative vomiting (POV) during the first and second day. A total of 1,433 participants from 17 clinical trials were enrolled in this Network Meta-Analysis (NMA). Compared to placebo, ramosetron was the most effective treatment for PON 24 h after surgery (OR = 0.063, 95% Crl: 0.006-0.45), with a 69.2% probability. On the other hand, for POV, droperidol was the best treatment during the first 2 h with a 71.1% probability (OR = 0.029, 95% Crl: 0.003-0.25); while fosaprepitant was the most effective treatment at 0-24 h (OR = 0.027, 95% Crl: 0.007-0.094; 66.9% probability) and 0-48 h (OR = 0.036, 95% Crl: 0.006-0.18; 56.6% probability). Besides, ramosetron showed a significantly higher incidence of complete response (OR = 29. 95% Crl: 1.4-6.5e + 02), as well as lower requirement for rescue AED (OR = 0.022, 95% Crl: 0.001-0.2). Granisetron was associated with the lowest incidence of headache and excessive sedation. Conclusions: Compared with placebo, ramosetron appears to be the best prophylactic treatment for PON 24 h after craniotomy, with higher complete responses. Fosaprepitant appears to be the most effective prophylaxis option for POV on the first 0-24 and 0-48 h. Both may be better applied in combination with perioperative dexamethasone. These findings may guide clinicians to provide improved pharmacological prophylaxis for PONV after craniotomy with fewer adverse effects.

The efficacy and safety of granisetron with ondansetron for the prevention of post-operative nausea and vomiting in patients undergoing cesarean section under spinal anesthesia

“…PONV in cesarean section deliveries is still common due to the adverse effects of conventional antiemetics. [10][11][12] Figure 2: Systolic blood pressure (mmHg) Recent advances in 5-HT3 receptor antagonists such as granisetron and ondansetron have been shown to have no side effects and are popular with surgical teams. 13 However, their relative efficacy in different clinical situations is less well documented.…”

“…Antiemetic prophylaxis is now the recognized method for reducing PONV. 9,10 Preventive antiemetic medication is not only beneficial but can also help patients at higher risk of PONV avoid hospitalization and additional care costs. 11 Traditional antiemetics, although tried, have their own drawbacks.…”

The Effect of Aromatherapy Administration in the Decrease of Nausea in Post-Spinal Anesthesia Patients

“…These problems mainly involve postoperative nausea and vomiting (PONV), Soon and Yoon found that 27.1% of patients experienced PONV [8]. PONV is the most common postoperative complication, with an incidence rate as high as 50% after surgery [9].…”

Fosaprepitant Does Not Interfere With Commonly Used Intraoperative Neuromonitoring Modalities Under General Anesthesia: A Preliminary Study

“…A recent meta-analysis demonstrated fosaprepitant to be the most effective single agent for the prevention of craniotomy related PONV. 4 Craniotomy is known to be a risk factor for PONV, which can cause potentially catastrophic complications including surgical site bleeding, raised intracranial pressure, seizures, and death. 5 On the basis of the ubiquitous nature of the NK-1 receptor in the central and peripheral nervous system motor and sensory pathways, we sought to determine whether intraoperative fosaprepitant administration would interfere with electroencephalogram [EEG], somatosensory evoked potential [SSEP], or transcranial motor evoked potential [TcMEP] monitoring in patients undergoing general anesthesia.…”

“…Fosaprepitant is superior to both ondansetron 2 and droperidol 3 in preventing postoperative nausea and vomiting [PONV] after craniotomy in adult patients. A recent meta-analysis demonstrated fosaprepitant to be the most effective single agent for the prevention of craniotomy related PONV 4 . Craniotomy is known to be a risk factor for PONV, which can cause potentially catastrophic complications including surgical site bleeding, raised intracranial pressure, seizures, and death 5 …”