Prophylactic ondansetron for postoperative emesis.Meta-analysis of its effectiveness in patients with previous history of postoperative nausea and vomiting

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Abstract
Background: The objective of this study was to compare, by means of meta-analysis, the postoperative antiemetic efficacy of ondansetron in patients with and without antecedents of postoperative nausea and vomiting. Methods: MEDLINE and EMBASE databases were searched for randomised placebo-controlled trials which evaluated the antiemetic effectiveness of 4 mg and 8 mg intravenous doses of prophylactic ondansetron in adult patients. A further selection was with respect to those studies which noted the patient's previous history of postoperative nausea and vomiting (PH-PONV) and, for the meta-analysis, the patients were divided into two sub-groups: those with (PH-PONV +) and those without a previous history of postoperative nausea and vomiting (PH-PONV −). Absence of vomiting was used as the index of effectiveness. Results: Twenty-one trials involving 3984 patients (2446 in ondansetron groups and 1538 in placebo groups; 1163 PH-PONV(+) patients and 2821 PH-PONV(−) patients) met the selection criteria. The effectiveness of the 4 mg dose of ondansetron was: OR (95% CI)=2.40 (1.77–3.26) vs. 2.71 (2.23–3.30) for the patients of PH-PONV(+) and PH-PONV(−) sub-groups, respectively. For the 8 mg dose, the effectiveness of ondansetron was: PH-PONV(+)=4.21 (2.66–6.66) and PH-PONV(−)=2.61 (1.81–3.59). For neither of the doses evaluated was there any significant statistical difference between the sub-groups. Conclusions: The effectiveness of ondansetron in the prevention of postoperative vomiting is not affected by the patients’ PH-PONV.

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