British Journal of Anaesthesia, Vol 78, Issue 3 247-255, Copyright © 1997 by The Board of Management and Trustees of the British Journal of Anaesthesia
M. Tramer, A. Moore and H. McQuay
We have analysed randomized controlled studies which reported the incidence
of postoperative nausea and vomiting (PONV) after propofol anaesthesia
compared with other anaesthetics (control). Cumulative data of early (0-6
h) and late (0-48 h) PONV were recorded as occurrence or non-occurrence of
nausea or vomiting. Combined odds ratio and number- needed-to-treat were
calculated for propofol as an induction or maintenance regimen, early or
late outcomes, and different emetic events. This was performed for all
control event rates and within a range of 20-60% control event rates. We
analysed 84 studies involving 6069 patients. The effect of propofol on PONV
was dependent mainly on the method of administration, time of measurement
and range of control event rates. When all studies were included the
number-needed-to-treat to prevent PONV with propofol was more than 9 when
used for induction of anaesthesia and at best 6 when used for maintenance.
Within the 20- 60% control event rate range, best results were achieved
with propofol maintenance to prevent early PONV: the number-needed-to-treat
to prevent early nausea was 4.7 (95% confidence interval 3.8-6.3), vomiting
4.9 (4-6.1) and any emetic event 4.9 (3.7-7.1). Within the 20- 60% control
event rate, of five patients treated with propofol for maintenance of
anaesthesia, one will not vomit or be nauseated in the immediate
postoperative period who would otherwise have vomited or been nauseated.
This may be clinically relevant. In all other situations the difference
between propofol and control may have reached statistical significance but
was of doubtful clinical relevance. Treatment efficacy should be
established within a defined range of control event rates for meaningful
estimates of efficacy and for comparisons.
CLINICAL INVESTIGATIONS
Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies
Pain Research, Nuffield Department of Anaesthetics, The Churchill, Oxford Radcliffe Hospital, Headington, Oxford OX3 7LJ
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