Drugs for preventing postoperative nausea and vomiting

Abstract

Either nausea or vomiting is reported to affect, at most, 80 out of 100 people after surgery. If all 100 of these people are given one of the listed drugs, about 28 would benefit and 72 would not. Nausea and vomiting are usually less common and, therefore, drugs are less useful. For 100 people, of whom 30 would vomit or feel sick after surgery if given placebo, 10 people would benefit from a drug and 90 would not. Between one to five patients out of every 100 people may experience a mild side effect, such as sedation or headache, when given an antiemetic drug. Collaborative research should focus on determining whether antiemetic drugs cause more severe, probably rare, side effects. Further comparison of the antiemetic effect of one drug versus another is not a research priority.

Different treatment benefits were estimated by clinical trials performed in adults compared with those performed in children

“…Eighteen drugs were investigated by more than one review. For example, dexamethasone was investigated in six different reviews, two for its antiemetic action [33,57] and four for its antiinflammatory action [29,54,66,78] (see Appendix A at www.jclinepi.com).…”

“…Five meta-analyses included more than 10 pediatric RCTs [27,29,33,45,95]. For 36% (45/124) drugs, authors gave no precision of the age range or mean of the included children.…”

“…For the other 13 drugs, heterogeneity in the amount of the treatment effect was observed. For five drugs, the treatment benefit was higher in children compared with adults [30,33,90,97]. For nine drugs, the treatment benefit was higher for adults compared with children [18,27,32,34,41,67,104].…”

“…For 11 drugs with significant RORs, the doses were not adjusted according to the weight of children [18,27,30,32,34,41,67,90,104]. Children received an adjusted dose for ondansetron (0.10 to 0.15 mg/kg), for dolasetron (1 mg/kg), and for erythropoietin (600 IU/kg) [33,97].…”

“…Thirty-two showed a significant benefit in children and adults [23,25e28,32,33,36,38,43,45,55,57, 38 showed a potential benefit in adults but a potential harm in children [16,24,29,33,75,84,89,98,99], and six a potential benefit in children but a potential harm in adults [20,24,37,81,84,86,98] (see Appendix B at www.jclinepi.com, Web only).…”