Intravenous dexamethasone for prophylaxis of postoperative nausea and vomiting after administration of long-acting neuraxial opioids: a systematic review and meta-analysis.

Détails

ID Serval
serval:BIB_20E86AD2CB6C
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Intravenous dexamethasone for prophylaxis of postoperative nausea and vomiting after administration of long-acting neuraxial opioids: a systematic review and meta-analysis.
Périodique
Anaesthesia
Auteur(s)
Grape S., Usmanova I., Kirkham K.R., Albrecht E.
ISSN
1365-2044 (Electronic)
ISSN-L
0003-2409
Statut éditorial
Publié
Date de publication
04/2018
Peer-reviewed
Oui
Volume
73
Numéro
4
Pages
480-489
Langue
anglais
Notes
Publication types: Journal Article ; Meta-Analysis ; Systematic Review
Publication Status: ppublish
Résumé
Long-acting neuraxial opioids provide excellent analgesia after surgery, but are associated with higher rates of postoperative nausea and vomiting. Dexamethasone effectively prevents postoperative nausea and vomiting after general anaesthesia, but its value in patients receiving long-acting neuraxial opioids is undetermined. Therefore, the objective of this meta-analysis was to assess the prophylactic anti-emetic efficacy of intravenous (i.v.) dexamethasone in this population. The study methodology followed the PRISMA statement guidelines. The primary outcome was the need for rescue anti-emetics during the first 24 postoperative hours, analysed according to the dose of dexamethasone (low-dose 2.5-5.0 mg; intermediate dose 6.0-10.0 mg), timing of administration (beginning or end of surgery) and route of long-acting opioid administration (intrathecal or epidural). Additionally, the rates of complications (restlessness, infection, hyperglycaemia) were sought. Thirteen trials were identified, representing a total of 1111 patients. When compared with placebo, intravenous dexamethasone reduced the need for rescue anti-emetics (risk ratio (95%CI) 0.44 (0.35-0.56); I <sup>2</sup> = 43%; p < 0.00001; quality of GRADE evidence: moderate), without differences between dexamethasone doses (p for sub-group difference = 0.67), timing of administration (p for sub-group difference = 0.32) or route of long-acting opioid (p for sub-group difference = 0.10). No patients developed infection or restlessness among trials that sought these complications. No trial measured blood glucose levels. In conclusion, there is enough evidence to state that intravenous dexamethasone provides effective anti-emetic prophylaxis during the first 24 postoperative hours in patients who receive long-acting neuraxial opioids.
Mots-clé
Analgesics, Opioid/adverse effects, Antiemetics/administration & dosage, Antiemetics/therapeutic use, Dexamethasone/administration & dosage, Dexamethasone/therapeutic use, Drug Administration Schedule, Humans, Injections, Intravenous, Postoperative Care/methods, Postoperative Nausea and Vomiting/chemically induced, Postoperative Nausea and Vomiting/prevention & control, dexamethasone, epidural opioids, neuraxial opioids, postoperative nausea and vomiting, spinal opioids
Pubmed
Web of science
Open Access
Oui
Création de la notice
14/12/2017 17:40
Dernière modification de la notice
20/08/2019 12:57
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