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

Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, 251 E Huron St, F5-704, Chicago, IL 60611, USA.
BJA British Journal of Anaesthesia (Impact Factor: 4.85). 09/2012; 109(5):688-97. DOI: 10.1093/bja/aes325
Source: PubMed


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 prophylatic 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.

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    • "A dose of 10 mg of metoclopramide is commonly administered, and a recent meta-analysis showed that there were no side effects of metoclopramide, such as extrapyramidal symptoms, dizziness, headache, and sedation, at doses up to this level [21]. "
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    ABSTRACT: Postoperative nausea and vomiting (PONV) is a long-standing issue, not a new concept in anesthesiology. Despite many studies over the last several decades, PONV remains a significant problem due to its complex mechanism. This review presents a summary of the mechanism underlying the pathogenesis of PONV, focusing on preventive treatment, particularly the use of new drugs. In addition, we discuss the latest meta-analysis results regarding correct clinical use of classic drugs. I also summarize the latest trends of postdischarge nausea and vomiting and the pharmacogenetics, which is attracting a great deal of attention from other medical fields in PONV-related studies. Finally, we discuss the drawbacks of existing studies on PONV and suggest a focus for future investigations.
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    ABSTRACT: Objectives Incidence of postoperative nausea and vomiting (PONV) ranges from 20-30% in, routine procedures, up to 70-80% in high-risk patients. Prevention of PONV is usually based on, antiemetic drugs but pharmacological interventions are only partially effective, so we tested efficiency, of acupressure in PONV prevention. Design We included 180 patients American Society of Anaesthesiologists physical status classification, I and II, who underwent a laparotomy. The study was prospective, and placebo controlled. Nausea and, vomiting were separately monitored on patients with intravenous and epidural analgesia. Patients, were allocated in six groups, with 30 patients in each group: group I (epidural analgesia + acupressure), group II (epidural analgesia + metoclopramide), group III (epidural analgesia + sham acupressure), group IV (intravenous analgesia + acupressure), group V (intravenous analgesia + metoclopramide) and, group VI (intravenous analgesia + sham acupressure). Results Acupressure reduced PONV from 57 to 37% (P < 0.001) in patients with intravenous, postoperative analgesia, and from 63 to 20% (P < 0.001) in patients with epidural postoperative, analgesia compared to placebo. Metoclopramide has also reduced the incidence of PONV from 57 to, 40% (P = 0.003) in patients with intravenous postoperative analgesia and in patients with epidural, postoperative analgesia from 63 to 17% (P < 0.001) compared to placebo. Conclusions Our study confirmed positive effect of acupressure in PONV prevention in patients after, elective laparotomy, regardless of the type of postoperative analgesia, intravenous or epidural. Thus, since acupressure is a simple and inexpensive method of PONV prevention, without side effects, it, should be considered as standard for PONV prevention on laparatomy patients.
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