Dexamethasone for preventing postoperative nausea and vomiting after mastectomy

Abstract

Background: Postoperative nausea and vomiting (PONV) is a common complication after mastectomy. Although many researches have been studied the prophylactic effect of antiemetics, none of the results are effective. To overcome this problem, dexamethasone was used to relieve the occurrence of PONV. Since concerns about steroid-related morbidity still remain, We carried out a meta-analysis to evaluate the impact of prophylactic dexamethasone on PONV, post-operative pain undergoing mastectomy. Methods: Literature search was conducted through PubMed, Web of Science, EMBASE, MEDLINE, and Cochrane library database till June 2019 to identify eligible studies. Meanwhile, we also consulted some Chinese periodicals, such as China Academic Journals, Wanfang and Weipu. The research was reported according to the preferred reporting items for systematic reviews and meta-analysis guidelines. Randomized controlled trials were included in our meta-analysis. Meanwhile, the assessment of the risk of bias was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions version. The pooled data are processed by software RevMan 5.3. Results: Four studies with 490 patients were enrolled to this meta-analysis. Our study demonstrated that the dexamethasone group was significantly more effective than the placebo group in term of PONV (risk ratio [RR] = 0.46, 95% confidence intervals [CI]: 0.30–0.70, P = .0003), nausea (RR = 0.26, 95% CI: 0.10–0.68, P = .006) and vomiting (RR = 0.15, 95% CI: 0.04∼0.55, P = .004). The visual analog scale score was significantly diminished at 1 hour (weighted mean difference = -1.40, 95% CI: -1.53 to -1.26, P < .00001) in the dexamethasone group, while, no statistically significant difference was observed between the two groups in terms of visual analog scale at 24 hours (weighted mean difference = -0.56, 95% CI: -1.24 to 0.13, P = 0.11). Conclusion: Not only does Dexamethasone reduce the incidence of PONV but also decreases postoperative pain. However, we still need larger samples and higher quality studies to determine the relationship between symptoms and administration time to reach the conclusion. Trial registration number: PROSPERO CRD 42018118575

Efficacy and safety analysis of dexamethasone + palonosetron in prevention of post-embolization syndrome after D-TACE: A retrospective study

“…Tenghui Zhang et al [ 20 ] found that a single dose of 8mg dexamethasone can effectively reduce postoperative pain and shorten hospital stay. Leilai Xu et al [ 21 ] reported that dexamethasone can not only reduce the incidence of PONV, but also reduce postoperative pain. It is reported by Elizabeth A Klag et al [ 22 ] that dexamethasone can effectively control the occurrence of postoperative pain, nausea and vomiting.…”

Effect of Erector Spinae Block and PECS Block on Quality of Recovery and Analgesia After Modified Radical Mastectomy

“…Also, a high incidence of post-operative nausea and vomiting has been found in patients with MRM, and the use of opioids and NSAIDs may increase the incidence of postoperative nausea and vomiting. 15 Transdermal patch is a non-invasive method of providing post-operative analgesia and has been found to be very effective in reducing pain scores in the post-operative period in various other surgeries. But transdermal patches generally contain opioids and NSAIDs, which can again increase the incidence of nausea and vomiting after MRM surgery.…”

Efficacy and safety analysis of dexamethasone-lipiodol emulsion in prevention of post-embolization syndrome after TACE: a retrospective analysis

“…Perioperative dexamethasone is effective to reduce the pain, nausea and vomiting after thyroid surgery, which was reported by Cheng et al [ 29 ]. Some studies have reported [ 30 ] not only does Dexamethasone reduce the incidence of PONV but also decreases postoperative pain. Because of this, we speculated that dexamethasone may also have very good safety and efficacy in controlling post-embolization syndrome after TACE.…”