The efficacy of 5-HT3 receptor antagonists for the prevention of postoperative vomiting following craniotomy: two studies in children and young adults.

The purpose of this meta-analysis was to estimate the efficacy of prophylactic administration of 5-HT3 receptor antagonists for postoperative vomiting (POV) in pediatric craniotomy patients at 24 hours. By updating a previously published systematic literature search, we found a recently published pediatric study to combine with the one already identified. The two published randomized placebo-controlled trials were combined for a total of 135 participants aged 2 to 20 (79 treatment and 56 controls). The only study drug was ondansetron. The combined relative risk (RR) of vomiting was not statistically significant in the treatment group compared to the control group (RR = 0.77; 95% CI: 0.50-1.19). There was also no evidence of efficacy for ondansetron in reducing the use of rescue antiemetics in the treatment group compared to the control group (RR = .71; 95% CI: 0.34-1.49). While combining these randomized placebo-controlled trials did not show efficacy for ondansetron in preventing POV in craniotomy patients aged 2 to 20, a clinically significant effect cannot be excluded, as even the combined sample size remained small. Thus, there is no current evidence for or against this class of drugs for preventing POV in children after craniotomy, and clinical decision-making must be based on studies in other populations and clinical experience. Ongoing assessment of nausea and vomiting and ongoing evaluation of the effectiveness of treatments in individual children and young adults remains an essential part of perianesthesia and postoperative neuroscience nursing.