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Meta-Analysis
. 2006 Jul 19;2006(3):CD004125.
doi: 10.1002/14651858.CD004125.pub2.

Drugs for preventing postoperative nausea and vomiting

Affiliations
Meta-Analysis

Drugs for preventing postoperative nausea and vomiting

J B Carlisle et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Drugs can prevent postoperative nausea and vomiting, but their relative efficacies and side effects have not been compared within one systematic review.

Objectives: The objective of this review was to assess the prevention of postoperative nausea and vomiting by drugs and the development of any side effects.

Search strategy: We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2004), MEDLINE (January 1966 to May 2004), EMBASE (January 1985 to May 2004), CINAHL (1982 to May 2004), AMED (1985 to May 2004), SIGLE (to May 2004), ISI WOS (to May 2004), LILAC (to May 2004) and INGENTA bibliographies.

Selection criteria: We included randomized controlled trials that compared a drug with placebo or another drug, or compared doses or timing of administration, that reported postoperative nausea or vomiting as an outcome.

Data collection and analysis: Two authors independently assessed trial quality and extracted outcome data.

Main results: We included 737 studies involving 103,237 people. Compared to placebo, eight drugs prevented postoperative nausea and vomiting: droperidol, metoclopramide, ondansetron, tropisetron, dolasetron, dexamethasone, cyclizine and granisetron. Publication bias makes evidence for differences among these drugs unreliable. The relative risks (RR) versus placebo varied between 0.60 and 0.80, depending upon the drug and outcome. Evidence for side effects was sparse: droperidol was sedative (RR 1.32) and headache was more common after ondansetron (RR 1.16).

Authors' conclusions: Either nausea or vomiting is reported to affect, at most, 80 out of 100 people after surgery. If all 100 of these people are given one of the listed drugs, about 28 would benefit and 72 would not. Nausea and vomiting are usually less common and, therefore, drugs are less useful. For 100 people, of whom 30 would vomit or feel sick after surgery if given placebo, 10 people would benefit from a drug and 90 would not. Between one to five patients out of every 100 people may experience a mild side effect, such as sedation or headache, when given an antiemetic drug. Collaborative research should focus on determining whether antiemetic drugs cause more severe, probably rare, side effects. Further comparison of the antiemetic effect of one drug versus another is not a research priority.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

Figure 1
Figure 1
Severe Funnel plot asymmetry: granisetron's effectiveness versus placebo is less than implied by the relative risk. [Each dot is an outcome from one study. Nausea is green. Vomiting is light blue. 'Nausea or Vomiting' is dark blue. Rescue antiemetic is pink. Dots overlap. Coloured vertical lines mark the summative relative risk for each outcome. The outcomes of dots closer to the top (SE 0.0) are more precise]
Figure 2
Figure 2
Funnel plot of studies of granisetron versus placebo (compare with additional figure 02). In this plot results from studies authored by Fujii et al are red; results from other studies are blue. The vertical lines are the corresponding estimates of effect: green is nausea; light blue is vomiting; dark blue is nausea or vomiting; pink is treatment.
Figure 3
Figure 3
Severe Funnel plot asymmetry: droperidol and granisetron's effectiveness are more similar than implied by the relative risk. [Each dot is an outcome from one study. Nausea is green. Vomiting is light blue. 'Nausea or Vomiting' is dark blue. Rescue antiemetic is pink. Dots overlap. Coloured vertical lines mark the summative relative risk for each outcome. The outcomes of dots closer to the top (SE 0.0) are more precise]
Figure 4
Figure 4
Funnel plot of studies of droperidol versus granisetron (compare with additional figure 09). In this plot results from studies authored by Fujii et al are red; results from other studies are blue. The vertical lines are the corresponding estimates of effect: green is nausea; light blue is vomiting; dark blue is nausea or vomiting; pink is treatment.
Figure 5
Figure 5
One relative risk is plotted for each side‐effect reported by each study: red are from studies by Fujii et al; blue are from studies by other authors. An equal risk for a side effect (relative risk one) was reported by Fujii et al for 128 out of 159 risks (they overlap on the dashed line RR=1 and so appear fewer than 128), and reported by other authors for 12 out of 102 risks.
Figure 6
Figure 6
Mild Funnel plot asymmetry: metoclopramide's effectiveness versus placebo is similar to the relative risk (closer than other antiemetics). Each dot is an outcome from one study. Nausea is green. Vomiting is light blue. 'Nausea or Vomiting' is dark blue. Rescue antiemetic is pink. Dots overlap. Coloured vertical lines mark the summative relative risk for each outcome. The outcomes of dots closer to the top (SE 0.0) are more precise].
Figure 7
Figure 7
Moderate Funnel plot asymmetry: droperidol's effectiveness versus placebo is less than implied by the relative risk. [Each dot is an outcome from one study. Nausea is green. Vomiting is light blue. 'Nausea or Vomiting' is dark blue. Rescue antiemetic is pink. Dots overlap. Coloured vertical lines mark the summative relative risk for each outcome. The outcomes of dots closer to the top (SE 0.0) are more precise]
Figure 8
Figure 8
Moderate Funnel plot asymmetry: ondansetron's effectiveness versus placebo is less than implied by the relative risk. [Each dot is an outcome from one study. Nausea is green. Vomiting is light blue. 'Nausea or Vomiting' is dark blue. Rescue antiemetic is pink. Dots overlap. Coloured vertical lines mark the summative relative risk for each outcome. The outcomes of dots closer to the top (SE 0.0) are more precise]
Figure 9
Figure 9
Severe Funnel plot asymmetry: metoclopramide and ondansetron's effectiveness are more similar than implied by the relative risk. [Each dot is an outcome from one study. Nausea is green. Vomiting is light blue. 'Nausea or Vomiting' is dark blue. Rescue antiemetic is pink. Dots overlap. Coloured vertical lines mark the summative relative risk for each outcome. The outcomes of dots closer to the top (SE 0.0) are more precise]
Figure 10
Figure 10
Moderate Funnel plot asymmetry: droperidol and metoclopramide's effectiveness are more similar than implied by the relative risks. [Each dot is an outcome from one study. Nausea green, Vomiting light blue, 'Nausea or vomiting' dark blue, Rescue antiemetic pink. Dots overlap. Coloured vertical lines mark the summative relative risk for each outcome. The outcomes of dots closer to the top (SE 0.0) are more precise]
Figure 11
Figure 11
Moderate Funnel plot asymmetry: droperidol and ondansetron's effectiveness are more similar than implied by the relative risk for vomiting (light blue). [Each dot is an outcome from one study. Nausea green, Vomiting light blue, 'Nausea or vomiting' dark blue, Rescue antiemetic pink. Dots overlap. Coloured vertical lines mark the summative relative risk for each outcome. The outcomes of dots closer to the top (SE 0.0) are more precise]
Analysis 1.1
Analysis 1.1
Comparison 1 PRIMARY ANALYSIS: Placebo versus Drug, Outcome 1 Nausea.
Analysis 1.2
Analysis 1.2
Comparison 1 PRIMARY ANALYSIS: Placebo versus Drug, Outcome 2 Vomiting.
Analysis 1.3
Analysis 1.3
Comparison 1 PRIMARY ANALYSIS: Placebo versus Drug, Outcome 3 Nausea or Vomiting.
Analysis 1.4
Analysis 1.4
Comparison 1 PRIMARY ANALYSIS: Placebo versus Drug, Outcome 4 Rescue antiemetic.
Analysis 2.1
Analysis 2.1
Comparison 2 PRIMARY ANALYSIS: No Treatment versus Drug, Outcome 1 Nausea.
Analysis 2.2
Analysis 2.2
Comparison 2 PRIMARY ANALYSIS: No Treatment versus Drug, Outcome 2 Vomiting.
Analysis 2.3
Analysis 2.3
Comparison 2 PRIMARY ANALYSIS: No Treatment versus Drug, Outcome 3 Nausea or Vomiting.
Analysis 2.4
Analysis 2.4
Comparison 2 PRIMARY ANALYSIS: No Treatment versus Drug, Outcome 4 Rescue antiemetic.
Analysis 3.1
Analysis 3.1
Comparison 3 PRIMARY ANALYSIS: Drug versus Drug, Outcome 1 Nausea.
Analysis 3.2
Analysis 3.2
Comparison 3 PRIMARY ANALYSIS: Drug versus Drug, Outcome 2 Vomiting.
Analysis 3.3
Analysis 3.3
Comparison 3 PRIMARY ANALYSIS: Drug versus Drug, Outcome 3 Nausea or Vomiting.
Analysis 3.4
Analysis 3.4
Comparison 3 PRIMARY ANALYSIS: Drug versus Drug, Outcome 4 Rescue antiemetic.
Analysis 4.1
Analysis 4.1
Comparison 4 PRIMARY ANALYSIS: Placebo versus Drugs, Outcome 1 Nausea.
Analysis 4.2
Analysis 4.2
Comparison 4 PRIMARY ANALYSIS: Placebo versus Drugs, Outcome 2 Vomiting.
Analysis 4.3
Analysis 4.3
Comparison 4 PRIMARY ANALYSIS: Placebo versus Drugs, Outcome 3 Nausea or Vomiting.
Analysis 4.4
Analysis 4.4
Comparison 4 PRIMARY ANALYSIS: Placebo versus Drugs, Outcome 4 Rescue antiemetic.
Analysis 5.1
Analysis 5.1
Comparison 5 PRIMARY ANALYSIS: No Treatment versus Drugs, Outcome 1 Nausea.
Analysis 5.2
Analysis 5.2
Comparison 5 PRIMARY ANALYSIS: No Treatment versus Drugs, Outcome 2 Vomiting.
Analysis 5.3
Analysis 5.3
Comparison 5 PRIMARY ANALYSIS: No Treatment versus Drugs, Outcome 3 Nausea or Vomiting.
Analysis 5.4
Analysis 5.4
Comparison 5 PRIMARY ANALYSIS: No Treatment versus Drugs, Outcome 4 Rescue antiemetic.
Analysis 6.1
Analysis 6.1
Comparison 6 PRIMARY ANALYSIS: Drugs versus Drugs, Outcome 1 Nausea.
Analysis 6.2
Analysis 6.2
Comparison 6 PRIMARY ANALYSIS: Drugs versus Drugs, Outcome 2 Vomiting.
Analysis 6.3
Analysis 6.3
Comparison 6 PRIMARY ANALYSIS: Drugs versus Drugs, Outcome 3 Nausea or Vomiting.
Analysis 6.4
Analysis 6.4
Comparison 6 PRIMARY ANALYSIS: Drugs versus Drugs, Outcome 4 Rescue antiemetic.
Analysis 7.1
Analysis 7.1
Comparison 7 PRIMARY ANALYSIS: Side effects; Placebo versus Drug, Outcome 1 Dizziness or vertigo.
Analysis 7.2
Analysis 7.2
Comparison 7 PRIMARY ANALYSIS: Side effects; Placebo versus Drug, Outcome 2 Drowsiness or sedation.
Analysis 7.3
Analysis 7.3
Comparison 7 PRIMARY ANALYSIS: Side effects; Placebo versus Drug, Outcome 3 Dry mouth.
Analysis 7.4
Analysis 7.4
Comparison 7 PRIMARY ANALYSIS: Side effects; Placebo versus Drug, Outcome 4 Extrapyramidal reaction.
Analysis 7.5
Analysis 7.5
Comparison 7 PRIMARY ANALYSIS: Side effects; Placebo versus Drug, Outcome 5 Headache.
Analysis 7.6
Analysis 7.6
Comparison 7 PRIMARY ANALYSIS: Side effects; Placebo versus Drug, Outcome 6 Infection.
Analysis 8.1
Analysis 8.1
Comparison 8 PRIMARY ANALYSIS: Side effects; No Treatment versus Drug, Outcome 1 Drowsiness or sedation.
Analysis 8.2
Analysis 8.2
Comparison 8 PRIMARY ANALYSIS: Side effects; No Treatment versus Drug, Outcome 2 Extrapyramidal reaction.
Analysis 9.1
Analysis 9.1
Comparison 9 PRIMARY ANALYSIS: Side effects; Drug versus Drug, Outcome 1 Drowsiness or sedation.
Analysis 10.1
Analysis 10.1
Comparison 10 SECONDARY ANALYSIS: Route versus Route, Outcome 1 Nausea.
Analysis 10.2
Analysis 10.2
Comparison 10 SECONDARY ANALYSIS: Route versus Route, Outcome 2 Vomiting.
Analysis 10.3
Analysis 10.3
Comparison 10 SECONDARY ANALYSIS: Route versus Route, Outcome 3 Nausea or Vomiting.
Analysis 10.4
Analysis 10.4
Comparison 10 SECONDARY ANALYSIS: Route versus Route, Outcome 4 Rescue antiemetic.
Analysis 11.1
Analysis 11.1
Comparison 11 SECONDARY ANALYSIS: Timing versus Timing, Outcome 1 Nausea.
Analysis 11.2
Analysis 11.2
Comparison 11 SECONDARY ANALYSIS: Timing versus Timing, Outcome 2 Vomiting.
Analysis 11.3
Analysis 11.3
Comparison 11 SECONDARY ANALYSIS: Timing versus Timing, Outcome 3 Nausea or Vomiting.
Analysis 11.4
Analysis 11.4
Comparison 11 SECONDARY ANALYSIS: Timing versus Timing, Outcome 4 Rescue antiemetic.
Analysis 12.1
Analysis 12.1
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 1 Nausea alizapride.
Analysis 12.2
Analysis 12.2
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 2 Nausea clonidine.
Analysis 12.3
Analysis 12.3
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 3 Nausea dexamethasone.
Analysis 12.4
Analysis 12.4
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 4 Nausea dolasetron.
Analysis 12.5
Analysis 12.5
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 5 Nausea domperidone.
Analysis 12.6
Analysis 12.6
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 6 Nausea droperidol.
Analysis 12.7
Analysis 12.7
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 7 Nausea ginger.
Analysis 12.8
Analysis 12.8
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 8 Nausea granisetron.
Analysis 12.9
Analysis 12.9
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 9 Nausea neostigmine.
Analysis 12.10
Analysis 12.10
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 10 Nausea ondansetron.
Analysis 12.11
Analysis 12.11
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 11 Nausea ramosetron.
Analysis 12.12
Analysis 12.12
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 12 Nausea tropisetron.
Analysis 12.13
Analysis 12.13
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 13 Vomiting alizapride.
Analysis 12.14
Analysis 12.14
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 14 Vomiting clonidine.
Analysis 12.15
Analysis 12.15
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 15 Vomiting dexamethasone.
Analysis 12.16
Analysis 12.16
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 16 Vomiting dolasetron.
Analysis 12.17
Analysis 12.17
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 17 Vomiting domperidone.
Analysis 12.18
Analysis 12.18
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 18 Vomiting droperidol.
Analysis 12.19
Analysis 12.19
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 19 Vomiting ginger.
Analysis 12.20
Analysis 12.20
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 20 Vomiting granisetron.
Analysis 12.21
Analysis 12.21
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 21 Vomiting metoclopramide.
Analysis 12.22
Analysis 12.22
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 22 Vomiting neostigmine.
Analysis 12.23
Analysis 12.23
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 23 Vomiting ondansetron.
Analysis 12.24
Analysis 12.24
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 24 Vomiting ramosetron.
Analysis 12.25
Analysis 12.25
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 25 Vomiting tropisetron.
Analysis 12.26
Analysis 12.26
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 26 Nausea or Vomiting clonidine.
Analysis 12.27
Analysis 12.27
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 27 Nausea or Vomiting dexamethasone.
Analysis 12.28
Analysis 12.28
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 28 Nausea or Vomiting dolasetron.
Analysis 12.29
Analysis 12.29
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 29 Nausea or Vomiting domperidone.
Analysis 12.30
Analysis 12.30
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 30 Nausea or Vomiting droperidol.
Analysis 12.31
Analysis 12.31
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 31 Nausea or Vomiting granisetron.
Analysis 12.32
Analysis 12.32
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 32 Nausea or Vomiting neostigmine.
Analysis 12.33
Analysis 12.33
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 33 Nausea or Vomiting ondansetron.
Analysis 12.34
Analysis 12.34
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 34 Nausea or Vomiting ramosetron.
Analysis 12.35
Analysis 12.35
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 35 Rescue antiemetic clonidine.
Analysis 12.36
Analysis 12.36
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 36 Rescue antiemetic dexamethasone.
Analysis 12.37
Analysis 12.37
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 37 Rescue antiemetic dolasetron.
Analysis 12.38
Analysis 12.38
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 38 Rescue antiemetic droperidol.
Analysis 12.39
Analysis 12.39
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 39 Rescue antiemetic granisetron.
Analysis 12.40
Analysis 12.40
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 40 Rescue antiemetic neostigmine.
Analysis 12.41
Analysis 12.41
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 41 Rescue antiemetic ondansetron.
Analysis 12.42
Analysis 12.42
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 42 Rescue antiemetic ramosetron.
Analysis 12.43
Analysis 12.43
Comparison 12 SECONDARY ANALYSIS: Dose versus Dose, Outcome 43 Rescue antiemetic tropisetron.
Analysis 13.1
Analysis 13.1
Comparison 13 POSTHOC ANALYSIS: Fujii et al versus other authors, Outcome 1 Nausea: granisetron.
Analysis 13.2
Analysis 13.2
Comparison 13 POSTHOC ANALYSIS: Fujii et al versus other authors, Outcome 2 Vomiting: granisetron.
Analysis 13.3
Analysis 13.3
Comparison 13 POSTHOC ANALYSIS: Fujii et al versus other authors, Outcome 3 Nausea or Vomiting: granisetron.
Analysis 13.4
Analysis 13.4
Comparison 13 POSTHOC ANALYSIS: Fujii et al versus other authors, Outcome 4 Rescue antiemetic: granisetron.
Analysis 13.5
Analysis 13.5
Comparison 13 POSTHOC ANALYSIS: Fujii et al versus other authors, Outcome 5 Nausea: droperidol versus granisetron.
Analysis 13.6
Analysis 13.6
Comparison 13 POSTHOC ANALYSIS: Fujii et al versus other authors, Outcome 6 Vomiting: droperidol versus granisetron.
Analysis 13.7
Analysis 13.7
Comparison 13 POSTHOC ANALYSIS: Fujii et al versus other authors, Outcome 7 Nausea or Vomiting: droperidol versus granisetron.
Analysis 13.8
Analysis 13.8
Comparison 13 POSTHOC ANALYSIS: Fujii et al versus other authors, Outcome 8 Rescue antiemetic: droperidol versus granisetron.
Analysis 13.9
Analysis 13.9
Comparison 13 POSTHOC ANALYSIS: Fujii et al versus other authors, Outcome 9 Side effects.

References

References to studies included in this review

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    2. 3219830

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    1. Abou Zeid H, Al‐Gahamdi A, Abdul‐Hadi M. Dolasetron decreases postoperative nausea and vomiting after breast surgery. Breast Journal of Anaesthesia 2002 Jul;8(4):216‐21. [; MEDLINE: ; CN‐00390043] - PubMed
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    1. Abramowitz MD, Oh TH, Epstein BS, Ruttimann UE, Friendly DS. The antiemetic effect of droperidol following outpatient strabismus surgery in children. Anesthesiology 1983 Dec;59(6):579‐83. [; MEDLINE: ] - PubMed
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References to studies excluded from this review

    1. Abouleish EI, Rashid S, Haque S, Giezentanner A, Joynton P, Chuang AZ. Ondansetron versus placebo for the control of nausea and vomiting during Caesarean section under spinal anaesthesia. Anaesthesia 1999 May;54(5):479‐82. [; MEDLINE: ] - PubMed
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    1. Alexander R, Fennelly M. Comparison of ondansetron and metoclopramide as premedicants to prevent postoperative nausea and vomiting following orthopedic‐ surgery. British Journal of Anaesthesia 1995 May;74:91. [; ISI:A1995RA77700296 ER]
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    1. Alon E, Zamboni P, Hossli G. Postoperative antiemetic prophylaxis with haloperidol and metoclopramid in differential dosages. Schweizerische medizinische Wochenschrift 1987 Mar;17(12):460. [; ISI:A1987G525100031 ER]
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    1. Alon E, Lenzlinger PM, Pasch T. Ondansetron 4 mg vs droperidol 1.25 mg in the prophylaxis of postoperative nausea and vomiting after alfentanil‐supplemented inhalation anesthesia. British journal of anaesthesia 1993 May;70:6. [; ISI:A1993LD22600012 ER] - PubMed
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    1. Ambesh SP, Dubey PK, Sinha PK. Ondansetron pretreatment to alleviate pain on propofol injection: a randomized, controlled, double‐blinded study. Anesthesia & Analgesia 1999 Jul;89(1):197‐9. [; MEDLINE: ] - PubMed
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Additional references

    1. Altman DG, Bland JM. Interaction revisited: the difference between two estimates. British Medical Journal 2003;326(7382):219. - PMC - PubMed
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    1. Apfel CC, Kranke P, Eberhart LHJ, Roos A, Roewer N. Comparison of predictive models for postoperative nausea and vomiting. British Journal of Anaesthesia 2002;88(2):234‐40. - PubMed
    1. Cohen MM, Duncan PG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. Anesthesia and Analgesia 1994;78:7‐16. - PubMed
    1. Eberhart LH, Mauch M, Morin AM, Wulf H, Geldner G. Impact of a multimodal anti‐emetic prophylaxis on patient satisfaction in high‐risk patients for postoperative nausea and vomiting. Anaesthesia 2002 Oct;57(10):1022‐7. [MEDLINE: ] - PubMed

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