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Review
. 2023 Sep 28:14:116.
doi: 10.4103/ijpvm.ijpvm_250_22. eCollection 2023.

Comparative Efficacy of Different Classes of Antiemetic Medications for the Prevention of Nausea and Vomiting in Cesarean Section: A Network Meta-Analysis

Zoleykha Asgarlou  1 , Elham Dehghanpour Mohammadian  2 , Sousan Houshmandi  3 , Mohammad Mohseni  4 , Sepideh Gareh Sheyklo  5 , Ahmad Moosavi  6 , Shiler Ahmadi  7
Affiliations
Review

Comparative Efficacy of Different Classes of Antiemetic Medications for the Prevention of Nausea and Vomiting in Cesarean Section: A Network Meta-Analysis

Zoleykha Asgarlou et al. Int J Prev Med. .

Abstract

Background: Antiemetic medications have been associated with the prevention of nausea and vomiting in cesarean section, although less is known about the comparative efficacy of different medication classes.

Methods: We conducted a systematic review with network meta-analyses to compare and rank antiemetic medication classes (5-HT3 receptor antagonists, dopamine receptor antagonists, corticosteroids, antihistamines, anticholinergic agents, sedatives, and opioid antagonists or partial agonists) in terms of preventing intra- and postoperative nausea and vomiting among patients undergoing cesarean section. We included all randomized controlled trials (RCTs) that evaluated any antiemetic medication classes' treatment for target outcomes. Network meta-analysis was conducted with a frequentist approach using the R netmeta package. A total of 58 trials were included (6,665 women undergoing cesarean section; mean age, 28.1 years). Results: Compared with placebo, all interventions reduced the odds of intraoperative nausea (except antihistamines), intraoperative vomiting (except antihistamines), postoperative nausea (except anticholinergic agents and opioid antagonists), and postoperative vomiting (except opioid antagonists). In terms of intraoperative nausea and both intra- and postoperative vomiting, sedatives ranked first among other medication classes.

Conclusions: The relative effect sizes for various classes of antiemetic medication in preventing nausea and vomiting in the cesarean section were modeled using the principles of network meta-analysis which may facilitate informed clinical decision-making.

Keywords: Antiemetics; cesarean section; nausea and vomiting; network meta-analysis.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Study selection for the meta-analysis
Figure 2
Figure 2
Risk of bias summary
Figure 3
Figure 3
Comparison-adjusted funnel plots of trials included in the network meta-analysis for each outcome
Figure 4
Figure 4
Network diagram representing direct comparisons among medication classes. The width of lines indicates the number of trials in which each direct comparison is made
Figure 5
Figure 5
Treatment efficacy in the prevention of nausea and vomiting among patients undergoing cesarean section. Heterogeneity statistics: intraoperative nausea (I2: 40.2, Q = 51.9); intraoperative vomiting (I2: 23.0, Q = 49.8); postoperative nausea (I2: 51.8.2, Q = 53.9); postoperative vomiting (I2: 47.2, Q = 34.9)
Figure 6
Figure 6
Results of P-score analysis in terms of each outcome
See this image and copyright information in PMC

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