Journal: Ann Surg 248(5):751-762, 2008. 42 References
Reprint: Department of Surgery, University Hospital, London Health Sciences Centre, Room C8-114, 339 Windermere Road, London, Canada N6A 5A5 (PJ Karanicolas, MD)
Faculty Disclosure: Abstracted by R. Ouellette, who has nothing to disclose.
Laparoscopic cholecystectomy (LC) is one of the most common surgical procedures performed in North America. Although serious adverse events are uncommon after LC, 50%-75% of patients experience postoperative nausea and vomiting (PONV). Surgeons and anesthetists may administer single or combinations of antiemetic drugs to patients in an effort to minimize the incidence and severity of PONV. Corticosteroids alone or in combination with traditional antiemetics may decrease the incidence of PONV. This systematic review and meta-analysis of 4 bibliographic databases, conference proceedings, reference lists of articles and textbooks, and contact with experts was conducted to determine the impact of prophylactic corticosteroid administration on PONV, pain and complications.
The authors evaluated the methodologic quality of trials, and extracted data regarding baseline characteristics, interventions, and outcomes. The results were pooled using a random-effects model, evaluating the degree of heterogeneity, and exploring potential explanations for heterogeneity. The full text of 23 studies was evaluated and, of these, 16 were eligible trials. All studies were published between 1999-2007 with sample sizes ranging from 43 to 5199.
Irrespective of the co-interventions of other antiemetic agents, dexamethasone reduced the incidence of nausea, vomiting, and PONV relative to placebo. Dexamethasone also seemed to reduce the severity of postoperative pain, although substantial unexplained heterogeneity was present. The incidence of headache and dizziness was similar between groups. Higher doses of dexamethasone (8-16 mg) are more effective at reducing symptoms than lower doses (2-5 mg). Dexamethasone does not increase the incidence of headaches or dizziness and may decrease the severity of postoperative pain. The efficacy of dexamethasone relative to other antiemetics and the optimal timing of administration remain uncertain. |
