Evaluation of the Effective Drugs for the Prevention of Nausea and Vomiting Induced by Morphine Used for Postoperative Pain: A Quantitative Systematic Review

Abstract

Postoperative nausea and vomiting (PONV) with morphine therapy develops in more than 60％ of patients after surgery, markedly reducing patient QOL. The prophylactic eŠect of several antiemetics has already been studied, but evaluations, and even those using the same drug, are not uniform. The present research involved a meta-analysis of randomized controlled trials on prophylactic drug therapy for PONV in patients receiving morphine for the treatment of postoperative pain. The e‹cacy of the prophylactic administration of the drugs was examined.As a result, meta-analysis ofˆve drugs was possible and the evidence of e‹cacy was shown for three drugs ranked in order of an increasing odds ratio (OR) and conˆdence interval (CI): dexamethasone (OR: 0.23, 95％ CI: 0.15-0.35, p＜ 0.00001), droperidol (OR: 0.27, 95％ CI: 0.21-0.34, p＜0.00001), and metoclopramide (OR: 0.48, 95％ CI: 0.30-0.75, p＜0.001). These results suggest that the three drugs are eŠective in prophylactic treatment for PONV. Of them, dexamethasone used as a prophylactic drug for PONV provided the best results. Dexamethasone was shown to reduce the incidence of PONV from 66-80％ to 16-50％ with a dose of 1.25 to 10 mg and to be suitable as aˆrst drug of choice.

The Effects of Stimulation of Acupressure Point P6 on Postoperative Nausea and Vomiting: A Review of Literature

“…Dexamethasone was also effective for the prevention of nausea and vomiting associated with opioid administration in women with a history of motion sickness. 28 Coloma et al 29 found dexamethasone 4 mg in combination with dolasetron 12.5 mg to be effective in reducing the number of patients who had nausea at home after undergoing …”

Prophylaxis of postoperative nausea and vomiting: controversies in the use of serotonin 5-hydroxytryptamine subtype 3 receptor antagonists

“…The reported incidence of OINV ranges from approximately 10% to 61% [117][118][119][120][121][122][123]. Although the precise cause of OINV is not known, contributing factors may include anesthetic regimen, type of surgery, age, and gender [117].…”

Postoperative Nausea and Vomiting: Cause, Prevention, and Treatment

“…A variety of causes of PONV have been described, including age, (10,14) female gender, (3,4,10,(14)(15)(16) type of surgery, (10,14,15) length of surgical procedure, (4,14,17) perioperative use of opioids, (7,10,(18)(19)(20)(21) anxiety, (14) history of motion sickness, (14,22) prior history of PONV, (14) anesthetic agent, (23,24) nonsmoker, (25) obesity, (14) and gastroparesis. (14) Although female patients are more likely to have PONV, there is not necessarily a relationship with the phase of menses, (26) although there is a report of increased PONV in the periovulatory and premenstrual periods.…”

“…(15) Surgery lasting over 2 h increases the risk of PONV. (4,17) Opioids reported to increase the occurrence of PONV are morphine (7,18,19) and fentanyl. (21,27) PONV occurs in 12% of patients receiving alfentanil, 34% receiving fentanyl, and 35% receiving sufentanil.…”

“…(63) Dexamethasone is a valuable adjunct to the treatment of PONV and provides excellent reduction of PONV. (18,(64)(65)(66)(67)(68)(69) A prophylactic combination of drugs rather than single medications improves the results in preventing PONV. (2,8,40,41,46,70,71) This is probably because of the multiple causative factors that would respond to a combination of drugs acting at different receptor sites.…”