Dexamethasone combined with other antiemetics for prophylaxis after laparoscopic cholecystectomy

Abstract

Background/Objective: Postoperative nausea and vomiting (PONV) is one of the most common and distressing adverse events after laparoscopic cholecystectomy (LC). A meta-analysis of randomized clinical trials (RCTs) was performed to determine the efficacy and safety of dexamethasone combined with other antiemetic in the prevention of PONV in patients undergoing LC. Methods: A systematic literature search was conducted to identify all relevant RCTs. The primary outcome was PONV in the early period (0–3 hours, 0–4 hours, or 0–6 hours), late period (>6 hours), and the overall period (0–24 hours). Results: Nine RCTs with a total of 1089 patients were included in the analysis. Pooled analysis showed that dexamethasone combined with other antiemetics provided significantly better prophylaxis than single antiemetics in the early period [odds ratio (OR): 0.34; 95% confidence interval (CI): 0.21–0.55; p < 0.001], late period (OR: 0.35; 95% CI: 0.22–0.57; p < 0.001), and the overall period (OR: 0.36; 95% CI: 0.27–0.49; p < 0.001). Correspondingly, rescue antiemetic usage was significantly less in the combination therapy group (OR: 0.22; 95% CI: 0.12–0.41; p < 0.001). The most frequently reported adverse events were headache, dizziness, and itching. The incidence of adverse events did not differ between the two groups. Conclusion: Dexamethasone combined with other antiemetics was significantly better than single antiemetics for prophylaxis of PONV in patients undergoing LC, without apparent side effects.

Keywords

• dexamethasone
• laparoscopic cholecystectomy
• postoperative nausea and vomiting