Dexamethasone Prevents Postoperative Nausea and Vomiting After Cesarean Section Under Neuraxial Anesthesia: A Systematic Review and Meta-Analysis
An-liang Li, Hong Gao, Shao-feng Lin, Yan-qiu Liu, Yong-qiang Yin
Department of Anesthesiology, Guizhou Medical University, Guiyang, Guizhou, China (mainland)
Med Sci Rev 2016; 3:64-72
Background: We performed a meta-analysis to assess the effect of dexamethasone in reducing the occurrence of postoperative nausea or vomiting (PONV) and pruritus in parturient receiving neuraxial anesthesia with neuraxial opioids among cesarean section.
Material abd Methods: We searched PubMed, the Cochrane Central Register of Controlled Trials and EMBASE for all randomized controlled trials to compare dexamethasone with placebo for the prevention of PONV in parturients under a neuraxial anesthetic methods. Data were extracted independently by the authors. The incidence of PONV and pruritus in 24 hours, use of rescue anti-emetics, early pain scores at or around 4 hours and postoperative pain scores at 24 hours were statistics. Using the Review Manager (Review Manager version 5.3 (Cochrane Collaboration, Oxford, UK) complete meta-analysis and calculating the Odds ratio(OR) and 95% confidence interval (CI).
Results: Finally, seven randomized controlled trails were included in the study. From these trials, total 484 patients were analyzed with 241 receiving dexamethasone and 243 receiving placebo. At 24 hours after surgery, compared with placebo, dexamethasone reduced the incidence of postoperative nausea (OR [95% CI]=0.42 [0.26, 0.67]), postoperative vomiting (OR [95% CI]=0.38[0.24,0.62]) and the use of rescue antiemetic (OR [95% CI]=0.21 [0.10, 0.44]). Dexamethasone also reduced early pain scores at or around 4 hours (MD [95% CI]=–0.85[–1.59, –0.10]) and 24-hour visual analog pain scores (MD [95% CI]=–0.89(–1.35, –0.43)]. However, dexamethasone cannot reduce the incidence of pruritus (OR [95% CI]=0.86 [0.54, 1.38]).
Conclusions: Dexamethasone is an effective antiemetic for parturient receiving neuraxial opioids for cesarean section. However, dexamethasone was not unavailable for against neuraxial opioid-induced pruritus.
Keywords: Anesthesia, Spinal, Cesarean Section, Dexamethasone, Postoperative Nausea and Vomiting