Perioperative antiemetic efficacy of dexamethasone versus 5-HT3
receptor antagonists: a meta-analysis and trial sequential analysis
of randomized controlled trials
Preet Mohinder Singh
Jeetinder Kaur Makkar
Received: 1 March 2018 / Accepted: 24 May 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
Background Dexamethasone has many desirable pharmacologic properties for perioperative use. Its antiemetic potential has
been a focus of many recent trials.
Methods Trials comparing dexamethasone to 5-HT3-receptor antagonists (5HT3-RA) for 24 h postoperative vomiting inci-
dences published till August 2017 were searched in the medical database. Comparisons for antiemetic efficiency variables
(vomiting incidence, nausea incidence, rescue antiemetic need, and patients with complete response) during early (until 6 h)
and late postoperative phase were made. Comparative analgesic requirements were also evaluated.
Results Twenty randomized controlled double-blinded trials were included in the final analysis. Twenty-four-hour vomiting
incidence was similar (Fixed-effects, P =0.86,I
= 2.94%). Trial sequential analysis (TSA) confirmed non-inferiority of dexa-
methasone for 24-h vomiting incidence. (α =5%, β =20%, δ = 10%) with Binformation size^ being 1619 (required > 573).
Equivalence was also verified from early and delayed nausea rate as well using TSA. Pooled results did not demonstrate
superiority/inferiority of 5-HT3-RAs over dexamethasone in all other antiemetic efficacy variables (early and delayed).
Heterogeneity was found to be low in all of the comparisons. Linear-positive dose-response curve for dexamethasone 24-h
vomiting and nausea incidence was seen (correlation coefficient being 0.21 and 0.28, respectively). Dexamethasone reduced the
analgesic need (MH-odds of 0.64 (95% CI being 0.44 to 0.93) P = 0.02, I2 = 0)). Possibility of publication bias could not be ruled
out (Egger’s test, X-intercept = 1.41, P =0.04).
Conclusions Dexamethasone demonstrates equal antiemetic efficacy compared to 5-HT3 receptor antagonists. The agents per-
form equally well both in early postoperative phase and up to 24 h after surgery. Use of dexamethasone replacing 5-HT3 RAs
offers an additional advantage of lowering the opioid requirements during the perioperative period.
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00228-018-2495-4) contains supplementary
material, which is available to authorized users.
* Preet Mohinder Singh
Jeetinder Kaur Makkar
Department of Anesthesia, All India Institute of Medical Sciences,
New Delhi 110029, India
Department of Gastrointestinal surgery and Liver transplantation, All
India Institute of Medical Sciences, New Delhi 110029, India
Department of Anesthesia, Post Graduate Institute of Medical
Education and Research, Chandigarh 160012, India
Katz School of Medicine, Temple university, Philadelphia, PA, USA
Anesthesiology and Perioperative Medicine, Lewis Katz School of
Medicine, Temple University Health System,
Philadelphia, PA 19140, USA
European Journal of Clinical Pharmacology