Drugs for preventing postoperative nausea and vomiting in adults after general anesthesia: An abridged Cochrane network meta‐analysis

Abstract

Objective: In this abridged version of the recently published Cochrane review on antiemetic drugs, we summarize its most important findings and discuss the challenges and the time needed to prepare what is now the largest Cochrane review with network meta-analysis in terms of the number of included studies and pages in its full printed form. Methods:We conducted a systematic review with network meta-analyses to compare and rank single antiemetic drugs and their combinations belonging to 5HT 3 -, D 2 -, NK 1receptor antagonists, corticosteroids, antihistamines, and anticholinergics used to prevent postoperative nausea and vomiting in adults after general anesthesia.Results: 585 studies (97 516 participants) testing 44 single drugs and 51 drug combinations were included. The studies' overall risk of bias was assessed as low in only 27% of the studies. In 282 studies, 29 out of 36 drug combinations and 10 out of 28 single drugs lowered the risk of vomiting at least 20% compared to placebo. In the ranking of treatments, combinations of drugs were generally more effective than single drugs.Single NK 1 receptor antagonists were as effective as other drug combinations. Of the 10 effective single drugs, certainty of evidence was high for aprepitant, ramosetron, granisetron, dexamethasone, and ondansetron, while moderate for fosaprepitant and droperidol. For serious adverse events (SAEs), any adverse event (AE), and drug-class specific side effects evidence for intervention effects was mostly not convincing. Conclusions:There is high or moderate evidence for at least seven single drugs preventing postoperative vomiting. However, there is still considerable lack of evidence regarding safety aspects that does warrant investigation. K E Y W O R D Santiemetics, network meta-analysis, postoperative nausea and vomiting, systematic review, vomitingThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Include or not to include conference abstracts in systematic reviews? Lessons learned from a large Cochrane network meta-analysis including 585 trials

“…This study is a case study on the impact of randomized controlled studies published as conference abstracts only and which met otherwise the narrow eligibility criteria of the large Cochrane review published by Weibel et al [16,17]. This study has not been registered.…”

“…addition of new studies, new treatments, and new direct or indirect comparisons. Second, in sensitivity analyses, eligible abstracts were added to the primary NMAs published in the Cochrane review [16,17]. Details for NMA were described elsewhere [16,17].…”

“…Second, in sensitivity analyses, eligible abstracts were added to the primary NMAs published in the Cochrane review [16,17]. Details for NMA were described elsewhere [16,17]. We compared NMA effect estimates and ranking order of treatments of the primary NMA and the sensitivity analysis.…”

Copublication improved the dissemination of Cochrane reviews and benefited copublishing journals: a retrospective cohort study

“…Copublication of a shorter version of the Cochrane review might also help those readers who felt challenged by the full-length review. As an extreme example, the Cochrane review with the largest number of included studies (as of May 2022) is a network meta-analysis of drugs to prevent postoperative nausea and vomiting and, if printed, this would fill more than 2,200 pages [7], although its copublished versions take up only 11 [8] and nine pages [9].…”

“…0.001]. Similarly, the median number of citations in the first year, second year, third year, and fifth year after publication in the copublished group was higher than in the noncopublished group [1 (0, 3) vs. 0 (0, 1), 6 (3, 11.5) vs. 2 (1, 5), 8 (4, 15) vs. 3.5 (1, 8), 8 (4, 15) vs. 3 (1,9), respectively, all P ! 0.001] (Table 3).…”