Placebo-controlled efficacy of 5-HT3 antagonists for postoperative nausea and vomiting prophylaxis in supratentorial craniotomies: A systematic review and comparative meta-analysis of randomized clinical trials

Background: Postoperative nausea and vomiting (PONV) are common and distressing complications following neurosurgical procedures, affecting up to 73 % of patients undergoing craniotomy. Therefore, we aimed to assess the placebo-controlled efficacy of 5-HT3 antagonists to prevent PONV following supratentorial craniotomies.

Methods: We searched Medline, Web of Science, and Embase databases following PRISMA guidelines for RCTs comparing the outcomes of prophylactic use of 5-HT3 antagonists with placebo to prevent PONV following supratentorial craniotomy. We pooled odds ratios (OR) with 95 % confidence intervals with a random-effects model. I² statistics was used to assess heterogeneity.

Results: Five RCTs, comprising 347 patients, of which 145 received a placebo, were included. The analysis identified a lower likelihood of early postoperative vomiting in 5-HT3 antagonists group (OR=0.47; 95 % CI: 0.24-0.91, p<0.05; I²=7 %), a lower likelihood of vomit within the 24-h period in 5-HT3 antagonists group (OR=0.27; 95 % CI: 0.15-0.48, p<0.01; I²=40 %), a lower likelihood of nausea within the 24-h period in 5-HT3 antagonists group (OR=0.47; 95 % CI: 0.28-0.72, p<0.01; I²=34 %), and a lower likelihood of rescue interventions in 5-HT3 antagonists group (OR = 0.18; 95 % CI: 0.10-0.34; I² = 0 %. Subgroup analyses focusing on ondansetron also identified a lower likelihood of nausea and vomiting within the 24-h period in the 5-HT3 antagonist group.

Conclusion: This systematic review and meta-analysis identified that 5-HT3 antagonists are effective in preventing PONV in the postoperative period following supratentorial craniotomy when compared to placebo. Our findings provide synthesized and robust evidence derived from randomized studies to support the use of 5-HT3 antagonists in clinical practice.