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

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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, 黃慶, 陸彬堂.托烷司瓊聯合地塞米松預防剖宮產術后硬膜外鎮痛所致惡心嘔吐的臨床觀察.中國臨床新醫學, 2011, 4(1): 47-49.
8.	鐘穎, 李惠芳, 趙姝.地塞米松預防剖宮產術后鎮痛所致惡心嘔吐中的應用.云南醫藥, 2002, 23(1):41-42.
9.	鄭浩, 李儷伶, 徐旭仲.阿扎司瓊在預防剖宮產術后鎮痛藥物不良反應中的應用.山東醫藥, 2008, 48(23):73-74.
10.	周新春, 王新本, 崔小花, 等.氟哌利多聯合地塞米松防治術后鎮痛致惡心嘔吐、皮膚瘙癢的觀察.中國臨床醫生, 2004, 32(10):30-32.
11.	儲六生, 李娟.地塞米松或氟哌利多預防硬膜外嗎啡鎮痛惡心嘔吐的臨床觀察.安徽醫學, 2004, 25(5):425-426.
12.	唐興祥, 胡旭東, 黃盛輝.地塞米松對嗎啡引起的惡心嘔吐預防作用的臨床觀察.海南醫學, 2003, 14(7):41.
13.	石偉東, 張長青.地塞米松減少剖宮產術后硬膜外嗎啡鎮痛引起的惡心嘔吐的觀察.工企醫刊, 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, 黃慶, 陸彬堂.托烷司瓊聯合地塞米松預防剖宮產術后硬膜外鎮痛所致惡心嘔吐的臨床觀察.中國臨床新醫學, 2011, 4(1): 47-49.
8. 鐘穎, 李惠芳, 趙姝.地塞米松預防剖宮產術后鎮痛所致惡心嘔吐中的應用.云南醫藥, 2002, 23(1):41-42.
9. 鄭浩, 李儷伶, 徐旭仲.阿扎司瓊在預防剖宮產術后鎮痛藥物不良反應中的應用.山東醫藥, 2008, 48(23):73-74.
10. 周新春, 王新本, 崔小花, 等.氟哌利多聯合地塞米松防治術后鎮痛致惡心嘔吐、皮膚瘙癢的觀察.中國臨床醫生, 2004, 32(10):30-32.
11. 儲六生, 李娟.地塞米松或氟哌利多預防硬膜外嗎啡鎮痛惡心嘔吐的臨床觀察.安徽醫學, 2004, 25(5):425-426.
12. 唐興祥, 胡旭東, 黃盛輝.地塞米松對嗎啡引起的惡心嘔吐預防作用的臨床觀察.海南醫學, 2003, 14(7):41.
13. 石偉東, 張長青.地塞米松減少剖宮產術后硬膜外嗎啡鎮痛引起的惡心嘔吐的觀察.工企醫刊, 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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