Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis
Antagonistas do receptor da neurocinina-1 no tratamento de náusea e vômito no pós-operatório: revisão sistemática e meta-análise
Chiaki Murakami, Nami Kakuta, Shiho Satomi, Ryuji Nakamura, Hirotsugu Miyoshi, Atsushi Morio, Noboru Saeki, Takahiro Kato, Naohiro Ohshita, Katsuya Tanaka, Yasuo M. Tsutsumi
Abstract
Background
Postoperative Nausea and Vomiting (PONV) is a common complication of general anesthesia. Several kinds of antiemetics, including 5-Hydroxytryptamine3 (5-HT3) receptor antagonists and Neurokinin-1 (NK-1) receptor antagonists, have been used to treat PONV.
Objectives
To compare the antiemetic effect of NK-1 receptor antagonists, including fosaprepitant.
Data sources
Online databases (PubMed, MEDLINE, Scopus, The Cochrane Library databases) were used.
Study eligibility criteria, participants, and interventions
Randomized Controlled Trials (RCTs) performed in patients over 18 years with ASA-PS of I‒III, aimed to assess the efficacy of antiemetics including NK-1 receptor antagonists and 5-HT3 receptor antagonists, and compared the incidence of PONV were included.
Study appraisal and synthesis methods
All statistical assessments were conducted by a random effect approach and odds ratios and 95% Confidence Intervals were calculated.
Results
Aprepitant 40 mg and 80 mg significantly reduced the incidence of vomiting 0‒24 h ours postoperatively (Odds Ratio [OR = 0.40]; 95% Confidence Interval [95% CI 0.30‒0.54];p < 0.001, and OR = 0.32; 95% CI 0.19‒0.56; p < 0.001). Fosaprepitant could also reduce the incidence of vomiting significantly both 0‒24 h and 0‒48 hours postoperatively (OR = 0.07; 95% CI 0.02‒0.24; p < 0.001 and OR = 0.07; 95% CI 0.02‒0.23; p < 0.001).
Limitations
Risk factors for PONV are not considered, RCTs using multiple antiemetics are included, RCTs for fosaprepitant is small, and some bias may be present.
Conclusions and implications of key findings
Aprepitant and fosaprepitant can be effective prophylactic antiemetics for postoperative vomiting. However, more studies are required for higher-quality meta-analyses.
Systematic review registration number
CRD42019120188.
Keywords
Resumo
Histórico
Náusea e Vômito no Pós-Operatório (NVPO) é um evento adverso frequente da anestesia geral. Várias classes de antieméticos, incluindo antagonistas do receptor 5-Hidroxitriptamina3 (5-HT3) e antagonistas do receptor da Neurocinina-1 (NK-1), têm sido utilizados para tratar a NVPO.
Objetivo
Comparar o efeito antiemético dos antagonistas do receptor NK-1, incluindo o fosaprepitanto.
Fontes de dados
Foram utilizadas bases de dados on-line (PubMed, MEDLINE, Scopus, The Cochrane Library).
Critérios de elegibilidade do estudo, participantes e intervenções
Foram incluídos Estudos Clínicos Randomizados (ECR) realizados em pacientes acima de 18 anos classificação ASA I a III, com o objetivo de avaliar a eficácia de antieméticos que incluíssem antagonistas do receptor NK-1 e antagonistas do receptor 5-HT3, e que comparassem a incidência de NVPO.
Métodos de avaliação e síntese do estudo
Todas as avaliações estatísticas foram realizadas por abordagem de efeito aleatório e foram calculadas razões de chances e Intervalos de Confiança de 95%.
Resultados
As doses de 40 mg e 80 mg de aprepitanto reduziram significantemente a incidência de vômito no período de 0 a 24 horas pós-operatórias (razão de chances [OR = 0,40]; Intervalo de Confiança de 95% [95% IC] 0,30‒0,54; p < 0,001 e OR = 0,32; 95% IC 0,19‒0,56; p < 0,001). O fosaprepitanto pode também reduzir significantemente a incidência de vômito tanto de 0‒24 h como no período de 0‒48 horas pós-operatórias (OR = 0,07; 95% IC 0,02‒0,24; p < 0,001 e OR = 0,07; 95% IC 0,02‒0,23; p < 0,001).
Limitações
Os fatores de risco para NVPO não foram analisados, ECRs usando múltiplos antieméticos foram incluídos, ECRs para fosaprepitanto tinham amostras pequenas, podendo haver algum viés.
Conclusões e implicações dos principais achados
Aprepitanto e fosaprepitanto podem ser drogas antieméticas profiláticas efetivas para vômito no pós-operatório. No entanto, são necessários mais estudos para elaboração de meta-análises de melhor qualidade.
Número de registro da revisão sistemática
CRD42019120188.
Palavras-chave
References
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