The Efficacy of 5-HT3 Receptor Antagonists for the Prevention of Postoperative Nausea and Vomiting After Craniotomy: A Meta-Analysis

Abstract

The purpose of this meta-analysis was to assess the efficacy of prophylactic administration of 5-HT3 receptor antagonists for postoperative nausea and vomiting in neurosurgical patients at 24 and 48+ hours. After a systematic search, 7 published randomized placebo controlled trials involving 448 craniotomy patients (222 treatment, 226 control) were included in the meta-analysis. Study drugs included ondansetron, granisetron, and tropisetron. The cumulative incidence of emesis was significantly reduced in the treatment group at 24 hours [relative risk (RR)=0.50, 95% confidence interval (CI): 0.38-0.66] and 48+ hours (RR=0.52, 95% CI: 0.36-0.75). There were no differences between the treatment and control groups in the cumulative incidence of nausea at 24 hours (RR=0.76, 95% CI: 0.54-1.06) and 48+ hours (RR=0.81, 95% CI: 0.62-1.06). The cumulative incidence of both nausea and vomiting continued to increase after 24 hours in both groups. Despite the ability of 5-HT3 receptor antagonists to reduce emetic episodes, future investigations should seek to address the control of postoperative nausea and to reduce further postoperative emesis in this population.

Granisetron versus ondansetron for post-operative nausea and vomiting prophylaxis in elective craniotomies for brain tumors: A randomized controlled double-blind study

“…Our results are similar to that of other authors and a Meta-analysis who have reported lower efficacy of 5HT3 antagonist for nausea. [1210] Retching was highest in group D (16%) and least in group G (4%). Most of the studies on PONV in patients undergoing craniotomy have not commented on the incidence of retching as a separate symptom.…”

“…Most of the studies on PONV in patients undergoing craniotomy have not commented on the incidence of retching as a separate symptom. [123] Post-operative retching is the most neglected PONV symptom, which by causing increase in arterial and intracranial pressure may cause major medical morbidity and therefore should be properly addressed in post craniotomy patients.…”

“…[1] Secondly, in addition to causing fluid and electrolyte imbalances, emesis may precipitate an increase in intracranial and cerebral intravascular pressures, jeopardizing hemostasis and cerebral perfusion. [2] Thirdly, depressed airway reflexes in the immediate post-operative period due to residual effect of anesthetic drugs and involvement of lower cranial nerves augment the chances of pulmonary aspiration. [3] Fourthly, the need for neurocognitive monitoring post-operatively makes use of sedating antiemetic undesirable in these patients.…”

“…[3] Fourthly, the need for neurocognitive monitoring post-operatively makes use of sedating antiemetic undesirable in these patients. [2]…”

The Fujii story

“…[6][7][8] One of them, Carlisle and Stevenson, 8 Nevertheless, starting in 2010, several significant things happened almost simultaneously. Although they all seemed to have contributed to Fujii's end, it is speculation as to whether they actually influenced each other.…”