Efficacy of ondansetron for postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery: a meta-analysis of randomized controlled trials

Abstract

Objective To evaluate the effcacy and safety of 5-HT3 receptor inhibitor ondansetron injected in the postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopic surgery under general anesthesia.Methods We searched the CNKI,CBM,Chongqing VIP,Wanfang Data Base,Pubmed,Springer,Embase,and Web of knowledge to identify randomized controlled trials (RCTs) about ondansetron in preventing PONV in patients undergoing gynecological laparoscopic surgery under general anesthesia from 1995 to 2012.We also consulted references of the included studies for omission.The methodological quality of the included RCTs was assessed and data were extracted according to the standard of the Cochrane Handbook 5.0.1.The meta-analyses were performed by Stata1 1.0 software.A total of 18 RCTs involving 1 597 patients were included.Results The results of meta-analyses showed that:① Effcacy:a single intravenous injection of ondansetron could decrease the incidence of PONV in patients undergoing gynecological laparoscopic surgery under general anesthesia (RR=0.210,95％CI=0.164-0.268),and a single 8 mg Ⅳ dose of ondansetron is no more effective than a single 4 mg Ⅳ dose of Ondansetron for prevention (RR=0.948,95％ CI =0.433-2.075),furthermore,ondanstron administered at the beginning of the gynecological laparoscopic procedures is more effective in preventing PONV than at the end of the surgery (RR=0.450,95％CI=0.290-0.698).Moreover,equivalent effcacy was seen between the ondansetron and droperidol in reducing PONV in patients undergoing gynecological laparoscopic survey,but the combination of ondansetron and droperidol further attenuated this incidence when compared to 4 mg ondansetron alone.② Safety:ondansetron injected could not significantly lessen the incidence of postoperative headache and fever.Conclusions A single 4 mg Ⅳ dose of ondansetron injected at the beginning of the gynecological laparoscopic survey can significantly decrease the incidence of PONV after general anesthesia,and it will not increase the adverse effect and the incidence of postoperative complications.And the combination of ondansetron and low dose of droperidol is more efficacious as a prophylactic antiemetic than ondansetron alone in women undergoing general anesthesia for gynecological laparoscopy. Key words: Randomized controlled trials; Meta-analysis; Ondansetron; Postoperative nausea and vomiting; gynecological; laparoscopic surgery