Abstract
BackgroundSerotonin (5-HT3) receptor antagonists are commonly used to decrease nausea and vomiting for surgery patients. We conducted a systematic review on the comparative efficacy of 5-HT3 receptor antagonists.MethodsSearches were done in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify studies comparing 5-HT3 receptor antagonists with each other, placebo, and/or combined with other antiemetic agents for patients undergoing surgical procedures. Screening search results, data abstraction, and risk of bias assessment were conducted by two reviewers independently. Random-effects pairwise meta-analysis and network meta-analysis (NMA) were conducted. PROSPERO registry number: CRD42013003564.ResultsOverall, 450 studies and 80,410 patients were included after the screening of 7,608 citations and 1,014 full-text articles. Significantly fewer patients experienced nausea with any drug relative to placebo, except for ondansetron plus metoclopramide in a NMA including 195 RCTs and 24,230 patients. Significantly fewer patients experienced vomiting with any drug relative to placebo except for palonosetron plus dexamethasone in NMA including 238 RCTs and 12,781 patients. All agents resulted in significantly fewer patients with postoperative nausea and vomiting versus placebo in a NMA including 125 RCTs and 16,667 patients.ConclusionsGranisetron plus dexamethasone was often the most effective antiemetic, with the number needed to treat ranging from two to nine.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0371-y) contains supplementary material, which is available to authorized users.
Highlights
Serotonin (5-HT3) receptor antagonists are commonly used to decrease nausea and vomiting for surgery patients
We present the network meta-analysis summary of treatment effects along with their 95 % confidence interval (CI) and 95 % predictive interval (PrI)
The literature search yielded 7,608 citations in total that met the search criteria, of which 450 full text articles met eligibility criteria for inclusion (444 primary publications and six companion reports reporting on nine studies, Fig. 1; Additional file 1: Appendix 2)
Summary
Serotonin (5-HT3) receptor antagonists are commonly used to decrease nausea and vomiting for surgery patients. Between 20 % and 65 % of patients undergoing surgery experience postoperative nausea and/or vomiting [2, 3]. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1W8, Canada. Serotonin (5-HT3) receptor antagonists reduce nausea and vomiting by inhibiting vagal nerves in the central nervous system and intestinal mucosa [8]. These agents are recommended by clinical practice guidelines for patients undergoing surgery and at risk for nausea and/or vomiting [9, 10]
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