PREVENTION OF VOMITING AFTER PEDIATRIC STRABISMUS SURGERY - A SYSTEMATIC REVIEW USING THE NUMBERS-NEEDED-TO-TREAT METHOD

Randomized controlled studies were reviewed to assess the effectivenes s and safety of antiemetics used for prophylaxis in paediatric strabis mus surgery. Early and late vomiting (6 and 48 h after operation, resp ectively), and adverse effects were evaluated using the numbers- neede d-to-treat method. In 27 reports with information on 2033 children, th e mean incidence of early vomiting was 54% and of late vomiting 59%, w ithout prophylaxis. Only three drugs were studied sufficiently for fir m conclusions to be drawn. In the best documented regimen (droperidol 75 mu g kg(-1)), four children have to be given the drug to prevent on e vomiting; of the three others, one may vomit and two would not have vomited anyway, fewer than one child in 100 may have an extrapyramidal reaction and 16 may have minor adverse effects. Metoclopramide 0.15 a nd 0.25 mg kg(-1) was significantly better than control only for early vomiting. Propofol had a high incidence of oculocardiac reflex withou t conferring any significant antiemetic effect: it should not be used. The benefits of prophylactic antiemetic therapy are not proven.