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Meta-Analysis
. 2019 May 24;9(5):e023729.
doi: 10.1136/bmjopen-2018-023729.

Herbal medications for anxiety, depression, pain, nausea and vomiting related to preoperative surgical patients: a systematic review and meta-analysis of randomised controlled trials

Ana Paula Nappi Arruda  1 , Yuchen Zhang  2 , Huda Gomaa  3 , Cristiane de Cássia Bergamaschi  4 , Caio Chaves Guimaraes  5 , Leonardo A R Righesso  6 , Mariana Del Grossi Paglia  4 , Silvio Barberato-Filho  4 , Luciane Cruz Lopes  4 , Ana Patricia Ayala Melendez  7 , Luciane Dias de Oliveira  8 , Lucas Paula-Ramos  8 , Bradley Johnston  9 , Regina El Dib  8   10
Affiliations
Meta-Analysis

Herbal medications for anxiety, depression, pain, nausea and vomiting related to preoperative surgical patients: a systematic review and meta-analysis of randomised controlled trials

Ana Paula Nappi Arruda et al. BMJ Open. .

Abstract

Objective: To summarise the effects of herbal medications for the prevention of anxiety, depression, pain, and postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic, obstetrical/gynaecological or cardiovascular surgical procedures.

Methods: Searches of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and LILACS up until January 2018 were performed to identify randomised controlled trials (RCTs). We included RCTs or quasi-RCTs evaluating any herbal medication among adults undergoing laparoscopic, obstetrical/gynaecological or cardiovascular surgeries. The primary outcomes were anxiety, depression, pain and PONV. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate overall certainty of the evidence for each outcome.

Results: Eleven trials including 693 patients were eligible. Results from three RCTs suggested a statistically significant reduction in vomiting (relative risk/risk ratio (RR) 0.57; 95% CI 0.38 to 0.86) and nausea (RR 0.69; 95% CI 0.50 to 0.96) with the use of Zingiber officinale (ginger) compared with placebo in both laparoscopic and obstetrical/gynaecological surgeries. Results suggested a non-statistically significantly reduction in the need for rescue medication for pain (RR 0.52; 95% CI 0.13 to 2.13) with Rosa damascena (damask rose) and ginger compared with placebo in laparoscopic and obstetrical/gynaecological surgery. None of the included studies reported on adverse events (AEs).

Conclusions: There is very low-certainty evidence regarding the efficacy of both Zingiber officinale and Rosa damascena in reducing vomiting (200 fewer cases per 1000; 288 fewer to 205 fewer), nausea (207 fewer cases per 1000; 333 fewer to 27 fewer) and the need for rescue medication for pain (666 fewer cases per 1000; 580 fewer to 752 more) in patients undergoing either laparoscopic or obstetrical/gynaecological surgeries. Among our eligible studies, there was no reported evidence on AEs.

Prospero registration number: CRD42016042838.

Keywords: GRADE; cardiovascular surgery; gynecologic surgery; herbal, laparoscopy; obstetrical surgery; systematic review.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 2
Figure 2
Risk of bias.
Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.
Figure 3
Figure 3
Meta-analysis comparing herbal versus placebo on vomiting for laparoscopic or obstetrical-gynaecological.
Figure 4
Figure 4
Meta-analysis comparing herbal versus placebo on nausea for obstetrical-gynaecological.
Figure 5
Figure 5
Meta-analysis comparing herbal versus placebo on need for rescue medication for pain. Panel A: primary analysis considering laparoscopic or obstetrical/gynaecological surgeries. Panel B: sensitivity analysis excluding Gharabaghi et al study considering laparoscopic or obstetrical/gynaecological surgeries.
See this image and copyright information in PMC

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