Dexamethasone for Prophylaxis of Nausea and Vomiting after Epidural Opioids for Post-Cesarean Analgesia: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 WANGMin ,  YAOJian-rong , YANGFan , LIUPing , TONGLong-xia , HUANGWei

Department of Obstetrics, West China Second University Hospital/West China Women's and Children's Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

YAOJian-rong, Email: 879708355@qq.com

Keywords：

Dexamethasone; Cesarean section; Postoperative nausea and vomiting; Systematic review; Metaanalysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160144

Video：

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Objective To systematically review the effect of dexamethasone in preventing post-operative nausea and vomiting (PONV) associated with epidural opioids for post-cesarean section analgesia. Methods We searched PubMed, EMbase, CNKI, WanFang Data and CBM databases from inception to Dec. 31^th 2015, to collect randomized controlled trials (RCTs) comparing dexamethasone with placebo/blank for the prevention of PONV associated with epidural opioids for postcesarean section analgesia. Two reviewer independently screened literature, extracted data, and assess the risk of bias of included studies. Then, meta-analysis was conducted by using RevMan 5.3 software. Results A total of 11 RCTs from 10 papers involving 1 011 patients were included. The results of meta-analysis showed that, compared with the placebo/ blank group, the dexamethasone group had lower incidence rates of post-operative nausea (RR=0.50, 95% CI 0.39 to 0.65, P < 0.000 01), postoperative vomiting (RR=0.39, 95% CI 0.29 to 0.52, P < 0.000 01), PONV (RR=0.37, 95% CI 0.30 to 0.46, P < 0.000 01), and rescue antiemetic (RR=0.34, 95% CI 0.19 to 0.62, P=0.000 5). Conclusions Current evidence indicates that dexamethasone is effective for preventing PONV after epidural opioids for post-cesarean section analgesia. Due to the limited quantity and quality of the included studies, the above conclusion needs to be further verified by more high quality studies.

Citation： WANGMin, YAOJian-rong, YANGFan, LIUPing, TONGLong-xia, HUANGWei. Dexamethasone for Prophylaxis of Nausea and Vomiting after Epidural Opioids for Post-Cesarean Analgesia: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(8): 933-938. doi: 10.7507/1672-2531.20160144 Copy

1.	Kotelko DM, Rottman RL, Wright WC, et al. Transdermal scopolamine decreases nausea and vomiting following cesarean section in patients receiving epidural morphine. Anesthesiology, 1989, 71(5):675-678.
2.	Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth, 1995, 42(10):891-903.
3.	Wang JJ, Ho ST, Liu YH, et al. Dexamethasone decreases epidural morphine-related nausea and vomiting. Anesth Analg, 1999, 89(1): 117-120.
4.	Tzeng JI, Wang JJ, Ho ST, et al. Dexamethasone for prophylaxis of nausea and vomiting after epidural morphine for post-Caesarean section analgesia:comparison of droperidol and saline. Br J Anaesth, 2000, 85(6):865-8.
5.	Wang JJ, Ho ST, Liu YH, et al. Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy. Br J Anaesth, 1999, 83(5):772-775.
6.	JPT H, S G. Cochrane Handbook for Systematic Reviews of Interventions[updated March 2011] :The Cochrane Collaboration, 2011.
7.	檀文好, 黄庆, 陆彬堂.托烷司琼联合地塞米松预防剖宫产术后硬膜外镇痛所致恶心呕吐的临床观察.中国临床新医学, 2011, 4(1): 47-49.
8.	钟颖, 李惠芳, 赵姝.地塞米松预防剖宫产术后镇痛所致恶心呕吐中的应用.云南医药, 2002, 23(1):41-42.
9.	郑浩, 李俪伶, 徐旭仲.阿扎司琼在预防剖宫产术后镇痛药物不良反应中的应用.山东医药, 2008, 48(23):73-74.
10.	周新春, 王新本, 崔小花, 等.氟哌利多联合地塞米松防治术后镇痛致恶心呕吐、皮肤瘙痒的观察.中国临床医生, 2004, 32(10):30-32.
11.	储六生, 李娟.地塞米松或氟哌利多预防硬膜外吗啡镇痛恶心呕吐的临床观察.安徽医学, 2004, 25(5):425-426.
12.	唐兴祥, 胡旭东, 黄盛辉.地塞米松对吗啡引起的恶心呕吐预防作用的临床观察.海南医学, 2003, 14(7):41.
13.	石伟东, 张长青.地塞米松减少剖宫产术后硬膜外吗啡镇痛引起的恶心呕吐的观察.工企医刊, 2003, 16(5):25.
14.	Wang JJ, Ho ST, Wong CS, et al. Dexamethasone prophylaxis of nausea and vomiting after epidural morphine for post-Cesarean analgesia. Can J Anaesth, 2001, 48(2):185-190.
15.	Wu JI, Lo Y, Chia YY, et al. Prevention of postoperative nausea and vomiting after intrathecal morphine for Cesarean section: a randomized comparison of dexamethasone, droperidol, and a combination. Int J Obstet Anesth, 2007, 16(2):122-127.
16.	Research IGfA. Dexamethasone, granisetron, or both for the prevention of nausea and vomiting during chemotherapy for cancer. N Engl J Med, 1995, 332(1):1-5.
17.	Lopez-Olaondo L, Carrascosa F, Pueyo FJ, et al. Combination of ondansetron and dexamethasone in the prophylaxis of postoperative nausea and vomiting. Br J Anaesth, 1996, 76(6):835-840.
18.	M F, T H, CJ F, et al. Nausea in cancer chemotherapy is inversely related to urinary cortisol excretion. Br J Cancer, 1992, 65(5):779-780.
19.	Livrea P, Trojano M, Simone IL, et al. Acute changes in bloodCSF barrier permselectivity to serum proteins after intrathecal methotrexate and CNS irradiation. J Neurol, 1985, 231(6):336-339.
20.	Allen TK, Jones CA, Habib AS. Dexamethasone for the prophylaxis of postoperative nausea and vomiting associated with neuraxial morphine administration:a systematic review and meta-analysis. Anesth Analg, 2012, 114(4):813-822.

1. Kotelko DM, Rottman RL, Wright WC, et al. Transdermal scopolamine decreases nausea and vomiting following cesarean section in patients receiving epidural morphine. Anesthesiology, 1989, 71(5):675-678.
2. Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth, 1995, 42(10):891-903.
3. Wang JJ, Ho ST, Liu YH, et al. Dexamethasone decreases epidural morphine-related nausea and vomiting. Anesth Analg, 1999, 89(1): 117-120.
4. Tzeng JI, Wang JJ, Ho ST, et al. Dexamethasone for prophylaxis of nausea and vomiting after epidural morphine for post-Caesarean section analgesia:comparison of droperidol and saline. Br J Anaesth, 2000, 85(6):865-8.
5. Wang JJ, Ho ST, Liu YH, et al. Dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy. Br J Anaesth, 1999, 83(5):772-775.
6. JPT H, S G. Cochrane Handbook for Systematic Reviews of Interventions[updated March 2011] :The Cochrane Collaboration, 2011.
7. 檀文好, 黄庆, 陆彬堂.托烷司琼联合地塞米松预防剖宫产术后硬膜外镇痛所致恶心呕吐的临床观察.中国临床新医学, 2011, 4(1): 47-49.
8. 钟颖, 李惠芳, 赵姝.地塞米松预防剖宫产术后镇痛所致恶心呕吐中的应用.云南医药, 2002, 23(1):41-42.
9. 郑浩, 李俪伶, 徐旭仲.阿扎司琼在预防剖宫产术后镇痛药物不良反应中的应用.山东医药, 2008, 48(23):73-74.
10. 周新春, 王新本, 崔小花, 等.氟哌利多联合地塞米松防治术后镇痛致恶心呕吐、皮肤瘙痒的观察.中国临床医生, 2004, 32(10):30-32.
11. 储六生, 李娟.地塞米松或氟哌利多预防硬膜外吗啡镇痛恶心呕吐的临床观察.安徽医学, 2004, 25(5):425-426.
12. 唐兴祥, 胡旭东, 黄盛辉.地塞米松对吗啡引起的恶心呕吐预防作用的临床观察.海南医学, 2003, 14(7):41.
13. 石伟东, 张长青.地塞米松减少剖宫产术后硬膜外吗啡镇痛引起的恶心呕吐的观察.工企医刊, 2003, 16(5):25.
14. Wang JJ, Ho ST, Wong CS, et al. Dexamethasone prophylaxis of nausea and vomiting after epidural morphine for post-Cesarean analgesia. Can J Anaesth, 2001, 48(2):185-190.
15. Wu JI, Lo Y, Chia YY, et al. Prevention of postoperative nausea and vomiting after intrathecal morphine for Cesarean section: a randomized comparison of dexamethasone, droperidol, and a combination. Int J Obstet Anesth, 2007, 16(2):122-127.
16. Research IGfA. Dexamethasone, granisetron, or both for the prevention of nausea and vomiting during chemotherapy for cancer. N Engl J Med, 1995, 332(1):1-5.
17. Lopez-Olaondo L, Carrascosa F, Pueyo FJ, et al. Combination of ondansetron and dexamethasone in the prophylaxis of postoperative nausea and vomiting. Br J Anaesth, 1996, 76(6):835-840.
18. M F, T H, CJ F, et al. Nausea in cancer chemotherapy is inversely related to urinary cortisol excretion. Br J Cancer, 1992, 65(5):779-780.
19. Livrea P, Trojano M, Simone IL, et al. Acute changes in bloodCSF barrier permselectivity to serum proteins after intrathecal methotrexate and CNS irradiation. J Neurol, 1985, 231(6):336-339.
20. Allen TK, Jones CA, Habib AS. Dexamethasone for the prophylaxis of postoperative nausea and vomiting associated with neuraxial morphine administration:a systematic review and meta-analysis. Anesth Analg, 2012, 114(4):813-822.

Chinese Journal of Evidence-Based Medicine

Dexamethasone for Prophylaxis of Nausea and Vomiting after Epidural Opioids for Post-Cesarean Analgesia: A Meta-analysis

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