Placebo-controlled efficacy of 5-HT3 antagonists for postoperative nausea and vomiting prophylaxis in supratentorial craniotomies: A systematic review and comparative meta-analysis of randomized clinical trials

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2024-09-26 DOI:10.1016/j.clineuro.2024.108569

Marcio Yuri Ferreira , Gabriel Scarpioni Barbosa , João Damásio da Costa Neto , Gustavo de Oliveira Almeida , Silvio Porto Junior , André Melo de Faria , Leonardo Dozza de Sousa , Leonardo Januario Campos Cardoso , Stefeson Gomes Cabral Junior , João Paulo Liute Scarramal , Luis F. Fabrini Paleare , Marcelo Porto Sousa , Anthony Hong , Ana B. Santos , Fernando G.F. Oliveira , Raphael Bertani

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Abstract

Background

Postoperative nausea and vomiting (PONV) are common and distressing complications following neurosurgical procedures, affecting up to 73 % of patients undergoing craniotomy. Therefore, we aimed to assess the placebo-controlled efficacy of 5-HT3 antagonists to prevent PONV following supratentorial craniotomies.

Methods

We searched Medline, Web of Science, and Embase databases following PRISMA guidelines for RCTs comparing the outcomes of prophylactic use of 5-HT3 antagonists with placebo to prevent PONV following supratentorial craniotomy. We pooled odds ratios (OR) with 95 % confidence intervals with a random-effects model. I² statistics was used to assess heterogeneity.

Results

Five RCTs, comprising 347 patients, of which 145 received a placebo, were included. The analysis identified a lower likelihood of early postoperative vomiting in 5-HT3 antagonists group (OR=0.47; 95 % CI: 0.24–0.91, p<0.05; I²=7 %), a lower likelihood of vomit within the 24-h period in 5-HT3 antagonists group (OR=0.27; 95 % CI: 0.15–0.48, p<0.01; I²=40 %), a lower likelihood of nausea within the 24-h period in 5-HT3 antagonists group (OR=0.47; 95 % CI: 0.28–0.72, p<0.01; I²=34 %), and a lower likelihood of rescue interventions in 5-HT3 antagonists group (OR = 0.18; 95 % CI: 0.10–0.34; I² = 0 %. Subgroup analyses focusing on ondansetron also identified a lower likelihood of nausea and vomiting within the 24-h period in the 5-HT3 antagonist group.

Conclusion

This systematic review and meta-analysis identified that 5-HT3 antagonists are effective in preventing PONV in the postoperative period following supratentorial craniotomy when compared to placebo. Our findings provide synthesized and robust evidence derived from randomized studies to support the use of 5-HT3 antagonists in clinical practice.

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5-HT3拮抗剂对脑室上开颅手术术后恶心和呕吐预防的安慰剂对照疗效：随机临床试验的系统回顾和比较荟萃分析。

背景：术后恶心和呕吐（PONV）是神经外科手术后常见且令人痛苦的并发症，多达 73% 的开颅手术患者会出现这种症状。因此，我们旨在评估5-HT3拮抗剂预防脑室上开颅术后PONV的安慰剂对照疗效：我们按照 PRISMA 指南在 Medline、Web of Science 和 Embase 数据库中检索了比较预防性使用 5-HT3 拮抗剂和安慰剂预防脑室上部开颅术后 PONV 结果的 RCT。我们采用随机效应模型对几率比（OR）和 95 % 置信区间进行了汇总。I2统计用于评估异质性：共纳入了五项 RCT 研究，包括 347 名患者，其中 145 人接受了安慰剂治疗。分析发现，5-HT3 拮抗剂组术后早期呕吐的可能性较低（OR=0.47；95 % CI：0.24-0.91，p2=7 %），5-HT3 拮抗剂组在 24 小时内呕吐的可能性较低（OR=0.27；95 % CI：0.15-0.48，P2=40 %），5-HT3 拮抗剂组在 24 小时内出现恶心的可能性较低（OR=0.47；95 % CI：0.28-0.72，P2=34 %），5-HT3 拮抗剂组进行抢救干预的可能性较低（OR = 0.18；95 % CI：0.10-0.34；I2 = 0 %）。以昂丹司琼为重点的亚组分析还发现，5-HT3 拮抗剂组在 24 小时内出现恶心和呕吐的可能性较低：本系统综述和荟萃分析发现，与安慰剂相比，5-HT3 拮抗剂可有效预防颅内上开颅术后的 PONV。我们的研究结果提供了来自随机研究的综合有力证据，支持在临床实践中使用 5-HT3 拮抗剂。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.