Lhj. Eberhart et al., Droperidol compared to 5-HT3-antagonists for prophylaxis of postoperative nausea and vomiting - A meta-analysis of controlled randomised studies, ANASTH INTM, 42(2), 2001, pp. 58-69
Objective: Randomised controlled trials comparing prophylactic droperidol w
ith 5-HT3-receptor antagonists (dolasetron, granisetron, ondansetron, or tr
opisetron) to prevent postoperative nausea and vomiting (PONV) were include
d in a meta-analysis to estimate the relative efficacy of both treatments.
Materials and methods: Studies were systematically searched using Medline,
EMBASE, the Cochrane-Library, and the manufacturers' databases. The search
was completed by manual screening of the reference lists and current issues
of locally available anaesthesia journals. The main end point was defined
as complete absence of nausea, retching, and vomiting within 6 hours ("earl
y PONV") and within 48 hours ("late PONV") after treatment with either drop
eridol or a 5-HT3-receptor antagonist. The pooled odds-ratios (OR) and the
numbers-needed-to-treat (NNT) with their corresponding 95%-confidence inter
vals (given in parentheses) were calculated using a random effects model.
Results: A total of 62 studies with 7075 patients (3743 receiving droperido
l, 3332 receiving a 5-HT3-antagonist) were analysed. If all 5-HT3-antagonis
ts are grouped together, these drugs were significantly more effective than
droperidol to prevent both "early" and "late" PONV (OR: 1.51 (1.19-1.93) a
nd 1.56 (1.28-1.90) respectively). The corresponding NNTs (numbers of patie
nts who must be treated with a 5-HT3-antagonist to prevent one patient from
PONV that otherwise would have suffered from PONV though treatment oder by
being treated with droperidol) were 15 (9.5-36) for "early PONV" and 11.1
(7.7-18.9) for "late PONV"
These results are based mainly on studies using ondansetron and granisetron
that comprise more than 90% of all available studies. Dolasetron (2 studie
s) and Tropisetron (3 studies) are not yet sufficiently proven to be superi
or to droperidol.
Comparing the four different 5-HT3-antagonist, granisetron seems to be the
most effective drug ("early PONV" OR: 3.15 (2.19-4.54); "late PONV" OR: 2.9
6 (2.18-4.03)). However, this result must be interpreted with caution, as 1
9 out of the 20 available studies were published by the same group. The res
ults of the present analysis lead to the speculation that there might be a
systematical error biasing the data concerning granisetron.
Conclusion: The 5-HT3-antagonists are significantly more effective than dro
peridol. However, this difference is not of high clinical relevance, consid
ering the high NNT. Thus, droperidol still has an important place in the pr
ophylaxis of postoperative nausea and vomiting.