Systemic metoclopramide to prevent postoperative nausea and vomiting: a meta-analysis without Fujii’s studies

Abstract

Previous evidence suggested that 10 mg systemic metoclopramide is not effective to prevent postoperative nausea and/or vomiting (PONV) in patients receiving general anaesthesia. However, the evidence included data with questioned validity by the author Yoshitaka Fujii. The objective of the current study was to examine the effect of a systemic dose of 10 mg metoclopramide to prevent PONV. This quantitative systematic review was performed according to the PRISMA guidelines. A wide search was performed to identify randomized clinical trials that evaluated systemic 10 mg metoclopramide as a prophylactic agent to reduce PONV. Meta-analysis was performed using a random-effect model. Thirty trials evaluating the effect of 10 mg systemic metoclopramide in 3328 subjects on PONV outcomes were included. Metoclopramide reduced the incidence of 24 h PONV compared with control, odds ratio (OR) [95% confidence interval (CI)] of 0.58 (0.43-0.78), number needed to treat (NNT)=7.8. When evaluated as separate outcomes, metoclopramide also decreased the incidence of nausea over 24 h, OR (95% CI) of 0.51 (0.38-0.68), NNT=7.1, and vomiting over 24 h, OR (95% CI) of 0.51 (0.40-0.66), NNT=8.3. A post hoc analysis examining three studies with questioned validity performed by the author Yoshitaka Fujii that would meet criteria for inclusion in the current study did not demonstrate a significant benefit of metoclopramide compared with control on the incidence of 24 h PONV. Our findings suggest that metoclopramide 10 mg i.v. is effective to prevent PONV in patients having surgical procedures under general anaesthesia. Metoclopramide seems to be a reasonable agent to prevent PONV.

Transversus Abdominis Plane Block to Ameliorate Postoperative Pain Outcomes After Laparoscopic Surgery

“…[28][29][30][31][32][33][34][35][36][37] All TAP blocks were performed under ultrasound guidance. The median (interquartile range) number of patients in the included studies receiving TAP block was 34.5 (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43). The median (interquartile range) of the modified Jadad scale score was 4 (4-5).…”

“…The large variation of risk profiles and the differences in the number/dosage of prophylactic antiemetic drugs among studies might have contributed to the lack of benefit from TAP block on postoperative nausea and/or vomiting. [42][43][44] Nevertheless, few studies have reported on the beneficial effect of regional anesthesia techniques in more global recovery outcomes. 45 Our group has reported on the overall effect of TAP block to improve the quality of postsurgical recovery after laparoscopic surgery.…”

Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting

“…It may also exert an antiemetic effect through its prokinetic properties within the GI tract itself, potentially mediated through antagonism of D 2 receptors and agonism of 5-HT 4 receptors (Sanger et al, 2013; Tonini et al, 1995). Metoclopramide, given in doses of 10 mg, has been shown to an effective prophlaxis against PONV (Carlisle and Stevenson, 2006; De Oliveira et al, 2012). A recent meta-analysis showed no statistically significant amount of extrapyramidal symptoms, dizziness, headache, or sedation with this dose of metaclopramide (De Oliveira et al, 2012).…”

Postoperative nausea and vomiting

“…Contrary to earlier studies suggesting its efficacy only at high (20e30 mg) doses, a single intravenous 10-mg dose is effective in prophylaxis of early PONV with an NNT of approximately 7. 16 However, its side effect profile is less favourable than many alternative choices. EPS may occur up to 72 hours following a single dose, more commonly in young women in whom it should be avoided (Table 3).…”