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Hepato-gastroenterology Oct 2012The incidence of postoperative nausea and vomiting is truly high after laparoscopic cholecystectomy. Ondansetron and metoclopramide may be effective in preventing it.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIMS
The incidence of postoperative nausea and vomiting is truly high after laparoscopic cholecystectomy. Ondansetron and metoclopramide may be effective in preventing it. Our aim was to estimate the efficacy of ondansetron vs. metoclopramide in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy.
METHODOLOGY
We searched MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Science Citation Index Expanded, EMBASE etc. to obtain relevant randomized controlled trials until October 2011. Two authors independently assessed the trials for inclusion and extracted the data. The odds ratio (OR) for dichotomous data was used with 95% confidence intervals (CI). Sensitivity and subgroup analysis were performed, if necessary.
RESULTS
The total incidence of postoperative nausea and vomiting within 24 hours after laparoscopic cholecystectomy was 31% (74 of 235) in the ondansetron group and 56% (127 of 225) in the metoclopramide group (OR=0.33, 95%CI=0.22-0.49, p<0.00001, 12=49%). The total incidences of nausea and vomiting were lower in the ondansetron group (OR=0.28, 95%CI=0.15-0.54, p=0.0002, I²=0%) and (OR=0.31, 95%CI=0.17-0.55, p<0.0001, I²=0%), respectively.
CONCLUSIONS
Based on the evidence, ondansetron has a better effect than metoclopramide for preventing postoperative nausea and vomiting after laparoscopic cholecystectomy. If we ignore the price factor, ondansetron is recommended for adhibition.
Topics: Antiemetics; Cholecystectomy, Laparoscopic; Drug Administration Schedule; Female; Humans; Incidence; Male; Metoclopramide; Odds Ratio; Ondansetron; Postoperative Nausea and Vomiting; Time Factors; Treatment Outcome
PubMed: 22282127
DOI: 10.5754/hge11811 -
General Hospital Psychiatry 2024Long COVID can include impaired cognition ('brain fog'; a term encompassing multiple symptoms) and mental health conditions. We performed a systematic review and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Long COVID can include impaired cognition ('brain fog'; a term encompassing multiple symptoms) and mental health conditions. We performed a systematic review and meta-analysis to estimate their prevalence and to explore relevant factors associated with the incidence of impaired cognition and mental health conditions.
METHODS
Searches were conducted in Medline and PsycINFO to cover the start of the pandemic until August 2023. Included studies reported prevalence of mental health conditions and brain fog in adults with long COVID after clinically-diagnosed or PCR-confirmed SARS-CoV-2 infection.
FINDINGS
17 studies were included, reporting 41,249 long COVID patients. Across all timepoints (3-24 months), the combined prevalence of mental health conditions and brain fog was 20·4% (95% CI 11·1%-34·4%), being lower among those previously hospitalised than in community-managed patients(19·5 vs 29·7% respectively; p = 0·047). The odds of mental health conditions and brain fog increased over time and when validated instruments were used. Odds of brain fog significantly decreased with increasing vaccination rates (p = ·000).
CONCLUSIONS
Given the increasing prevalence of mental health conditions and brain fog over time, preventive interventions and treatments are needed. Research is needed to explore underlying mechanisms that could inform further research in development of effective treatments. The reduced risk of brain fog associated with vaccination emphasizes the need for ongoing vaccination programs.
Topics: Adult; Humans; Post-Acute COVID-19 Syndrome; Mental Health; Prevalence; COVID-19; SARS-CoV-2; Mental Fatigue
PubMed: 38447388
DOI: 10.1016/j.genhosppsych.2024.02.009 -
Journal of Clinical Nursing Dec 2015To provide evidence about whether intravenous metoclopramide continuous infusion is associated with fewer extrapyramidal side effects than bolus infusion. (Comparative Study)
Comparative Study Meta-Analysis Review
Risk of extrapyramidal side effects comparing continuous vs. bolus intravenous metoclopramide administration: a systematic review and meta-analysis of randomised controlled trials.
AIMS AND OBJECTIVES
To provide evidence about whether intravenous metoclopramide continuous infusion is associated with fewer extrapyramidal side effects than bolus infusion.
BACKGROUND
Many studies have described the effects produced by the administration of metoclopramide, as a continuous intravenous infusion or intravenous bolus directly, but there is a lack of consensus about the best administration of this drug to minimise extrapyramidal side effects.
DESIGN
A meta-analysis was conducted.
METHODS
The search data base was conducted in: Cochrane Library, PubMed, Web of Knowledge and Scopus, to collect randomised controlled trials examining the association between extrapyramidal side effects and intravenous metoclopramide continuous or bolus infusion. Meta-analyses were conducted for the eligible randomised controlled trials by Comprehensive Meta-Analysis. Risk difference and 95% CIs were calculated with the Cochran's Q-statistic, and heterogeneity was assessed with the I(2) test.
RESULTS
Eleven randomised controlled trials were included. Meta-analysis showed that continuous intravenous infusion of metoclopramide produced less extrapyramidal side effects (8%; 95% CI, 5-11%; p < 0·001; I(2) = 65%). These improvements were particularly strong in studies scored ≥3 in the Jadad scale (12%; 95% CI, 3-24%; I(2) = 0%), in emergency patients (12%; 95% CI, 2-25%; I(2) = 0%), in patients who used concomitant drugs (9%; 95% CI, 5-12%; I(2) = 80%) and when observation (8%; 95% CI, 5-14%; I(2) = 69%) or analogue scale (7%; 95% CI, 1-13%; I(2) = 64%) were used to quantify the number of extrapyramidal reactions in patients.
CONCLUSIONS
Compared with bolus administration, continuous intravenous infusion of metoclopramide reduces the appearance of extrapyramidal side effects.
RELEVANCE TO CLINICAL PRACTICE
Continuous infusion is an effective intervention to reduce in patients discomfort caused by the extrapyramidal side effects of metoclopramide. Clinicians also reduce the time spent on alleviating these unwanted effects.
Topics: Antiemetics; Basal Ganglia Diseases; Humans; Infusions, Intravenous; Injections, Intravenous; Metoclopramide; Randomized Controlled Trials as Topic; Risk
PubMed: 26373874
DOI: 10.1111/jocn.12984 -
Journal of Dental Anesthesia and Pain... Oct 2021Migraine headaches are the second leading cause of disability worldwide and are responsible for significant morbidity, reduction in the quality of life, and loss of... (Review)
Review
BACKGROUND
Migraine headaches are the second leading cause of disability worldwide and are responsible for significant morbidity, reduction in the quality of life, and loss of productivity on a global scale. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of ketamine on migraines and other primary headache disorders compared to placebo and other active interventions, such as midazolam, metoclopramide/diphenhydramine, and prochlorperazine/diphenhydramine.
METHODS
An electronic search of databases published up to February 2021, including Medline via PubMed, EMBASE, Web of Science, and Cochrane Library, a hand search of the bibliographies of the included studies, as well as literature and systematic reviews found through the search was conducted to identify randomized controlled trials (RCTs) investigating ketamine in the treatment of migraine/headache disorders compared to the placebo. The authors assessed the risk of bias according to the Cochrane Handbook guidelines.
RESULTS
The initial search strategy yielded 398 unduplicated references, which were independently assessed by three review authors. After evaluation, this number was reduced to five RCTs (two unclear risk of bias and three high risk of bias). The total number of patients in all the studies was 193. Due to the high risk of bias, small sample size, heterogeneity of the outcomes reported, and heterogeneity of the comparison groups, the quality of the evidence was very low. One RCT reported that intranasal ketamine was superior to intranasal midazolam in improving the aura attack severity, but not duration, while another reported that intranasal ketamine was not superior to metoclopramide and diphenhydramine in reducing the headache severity. In one trial, subcutaneous ketamine was superior to saline in migraine severity reduction; however, intravenous (I.V.) ketamine was inferior to I.V. prochlorperazine and diphenhydramine in another study.
CONCLUSION
Further double-blind controlled studies are needed to assess the efficacy of ketamine in treating acute and chronic refractory migraines and other primary headaches using intranasal and subcutaneous routes. These studies should include a long-term follow-up and different ketamine dosages in diagnosed patients following international standards for diagnosing headache/migraine.
PubMed: 34703891
DOI: 10.17245/jdapm.2021.21.5.413 -
Turkish Journal of Obstetrics and... Jun 2022This investigation examined the efficacy of ondansetron (intervention) versus metoclopramide (control) in managing parturient females with hyperemesis gravidarum (HG),...
This investigation examined the efficacy of ondansetron (intervention) versus metoclopramide (control) in managing parturient females with hyperemesis gravidarum (HG), by pooling data from randomized controlled trials (RCTs) using a meta-analysis approach. From inception until January 2022, five information sources were screened: Cochrane Central Register of Controlled Trials, Google Scholar, Scopus, PubMed and Web of Science. Quality assessment was done through the Cochrane Risk of Bias (version 2) assessment tool. The mean difference (MD) with 95% confidence interval (CI) was used to summarize the continuous data in a fixed- or random-effects model, depending on the extent of between-study heterogeneity. Five RCTs were included, comprising a total of 695 patients (355 and 340 females were assigned to ondansetron and metoclopramide, respectively). Four RCTs had an overall "low" risk of bias, whereas one RCT had an overall "some concerns" due to lack of sufficient information about randomization. There was no significant difference between both groups regarding the pregnancy-unique quantification of emesis and nausea score [MD=0.23, 95% CI (-0.42, 0.88), p=0.49], length of hospital stay [MD=-0.17 days, 95% CI (-0.35, 0.02), p=0.08], the number of doses of drug received [MD=0.45, 95% CI (-0.08, 0.98), p=0.10], and duration of intravenous fluids [MD=-1.73 hours, 95% CI (-5.79, 2.33), p=0.40]. Among parturient females with HG, there was no substantial difference in efficacy between both agents. Nevertheless, ondansetron is favored over metoclopramide in view of its trending therapeutic efficacy and better safety profile.
PubMed: 35770443
DOI: 10.4274/tjod.galenos.2022.14367 -
Contraception May 2013Nausea and vomiting are side effects of emergency contraception pill (ECP) use. Different ECP regimens and the use of antinausea drugs may prevent these side effects. (Review)
Review
BACKGROUND
Nausea and vomiting are side effects of emergency contraception pill (ECP) use. Different ECP regimens and the use of antinausea drugs may prevent these side effects.
METHODS
We conducted two searches to identify data pertaining to the prevention of nausea and vomiting with ECP use and management of emesis with ECP use. Both searches queried the PubMed and Cochrane databases for peer-reviewed articles, in any language, published on January 1966-February 2012. Types of ECP included in our searches were levonorgestrel (LNG), Yuzpe regimens or ulipristal acetate (UA). Our search strategy for data on management of emesis with ECP use also included the gray literature. The gray literature includes materials such as reports, patent claims, prescribing information and package labels that are not published commercially.
RESULTS
Eleven articles met the inclusion criteria. Split dose or two doses of LNG caused less nausea than UA and standard two-dose Yuzpe regimen in one study. Four studies demonstrated no difference between split-dose versus single-dose LNG. In two trials, meclizine and metoclopramide, given before Yuzpe ECPs, reduced nausea, but only meclizine reduced vomiting.
CONCLUSION
The evidence does not support routine use of antiemetics with ECP use. Data to guide management of emesis with ECP are limited to expert opinion and package labeling.
Topics: Antiemetics; Contraception, Postcoital; Female; Humans; Levonorgestrel; Nausea; Norpregnadienes; Vomiting
PubMed: 23121827
DOI: 10.1016/j.contraception.2012.09.031 -
Nutrition in Clinical Practice :... Apr 2022Metoclopramide is frequently prescribed as an adjuvant for the postpyloric placement of nasoenteric tubes (NETs). However, a recent meta-analysis showed that... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Metoclopramide is frequently prescribed as an adjuvant for the postpyloric placement of nasoenteric tubes (NETs). However, a recent meta-analysis showed that metoclopramide was not beneficial in adults. Thus, this study aimed to reevaluate the effect of metoclopramide on the postpyloric placement of NETs.
METHODS
A systematic search of PubMed, Embase, the Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure (CNKI), and Wanfang data was conducted up to August 2020 for randomized controlled trials (RCTs) comparing metoclopramide with placebo or no intervention. Trial sequential analysis (TSA) was used for the primary outcomes (the success rate of the postpyloric placement of NETs).
RESULTS
Seven eligible RCTs that included 520 participants were identified. The results of the pooled effect sizes showed that metoclopramide significantly facilitated the postpyloric placement of NETs (relative risk [RR], 1.48; 95% CI, 1.11-1.97; P = .007; I = 37%). However, the risk-of-bias assessment and the TSA results indicated that the qualities of the RCTs and the sample sizes were insufficient to confirm the efficacy of metoclopramide. Further subgroup analysis revealed that successful postpyloric placement was more pronounced in studies in which spiral NETs were employed (RR, 1.85; 95% CI, 1.41-2.43; P < .001; I = 0%). Additionally, overall adverse events were minimal.
CONCLUSIONS
The evidence accumulated so far was not strong enough to demonstrate metoclopramide's beneficial effects on the postpyloric placement of NETs. Further high-quality, large-sample RCTs are required to elucidate the effects of metoclopramide.
Topics: Adult; Critical Care; Enteral Nutrition; Humans; Intubation, Gastrointestinal; Metoclopramide; Randomized Controlled Trials as Topic
PubMed: 34155678
DOI: 10.1002/ncp.10725 -
International Emergency Nursing Jul 2016Migraine headache is a common disorder; patients attending Emergency Departments (ED) for migraine symptoms internationally account for 1-3% of total ED annual... (Review)
Review
Migraine headache is a common disorder; patients attending Emergency Departments (ED) for migraine symptoms internationally account for 1-3% of total ED annual attendances. A systematic review was undertaken of reports comparing the effectiveness of metoclopramide intravenously (IV) with that of sumatriptan subcutaneously (SC), in an ED setting, for the immediate relief of migraine and their measurable effects in relieving pain intensity. Findings of two identified comparable reports confirm the individual efficacy of the study drugs in pain relief. However, whilst one report concludes that there is no statistical or significant clinical advantage for one drug over the other, the other report suggests that metoclopramide has a distinct advantage. One study is well structured methodologically, but the other has significant risk of bias. The analysis of the chosen studies demonstrates the need for rigorous study design and robust reporting requirements to obviate this risk. Further studies are required to explore comparable effect. Implications for clinical practice from the report outcomes indicate the individual effectiveness of both study drugs in providing pain relief for migraine in the Emergency setting, but not the comparable efficacy of one drug over the other.
Topics: Adult; Analgesics; Emergency Service, Hospital; Female; Humans; Male; Metoclopramide; Migraine Disorders; Pain Management; Sumatriptan
PubMed: 26975891
DOI: 10.1016/j.ienj.2016.02.004 -
Metoclopramide for the treatment of gastroesophageal reflux disease in infants: a systematic review.Pediatrics Aug 2006Metoclopramide is a commonly used drug to treat gastroesophageal reflux disease in infants. Given its widespread use and growing concern about toxicity in this... (Comparative Study)
Comparative Study Review
OBJECTIVES
Metoclopramide is a commonly used drug to treat gastroesophageal reflux disease in infants. Given its widespread use and growing concern about toxicity in this population, we conducted a systematic review of metoclopramide for the treatment of gastroesophageal reflux disease in infants.
METHODS
We performed a systematic search of PubMed and bibliographies of relevant review articles. We included cohort, case-control, and intervention studies of the efficacy, effectiveness, or toxicity of metoclopramide therapy for gastroesophageal reflux disease in infants. We excluded case reports, case series, review articles, and abstracts.
RESULTS
Twelve articles met our inclusion criteria. Of these, 11 were prospective trials, and 5 were randomized, blinded clinical trials. Study size ranged from 6 to 77 patients. Eight studies showed patient improvement with metoclopramide in at least 1 measured outcome; 1 study showed worsening symptoms with metoclopramide. Of the 5 randomized, blinded trials, 2 showed no effect of metoclopramide on any outcome, and 2 showed a significant placebo effect. Four studies commented on adverse effects of therapy, with irritability being the most frequently reported potential adverse effect of therapy. Other reported adverse effects included dystonic reactions, drowsiness, oculogyric crisis, emesis, and apnea. Among studies, there was marked heterogeneity in the patient populations, dosing, and outcomes studied. Therefore, a meta-analysis was not performed. We both agreed on a US Preventive Service Task Force rating of "poor" for the level of evidence, leading to an "inconclusive" recommendation for the safety and efficacy of metoclopramide in infants.
CONCLUSIONS
The current literature is insufficient to either support or oppose the use of metoclopramide for gastroesophageal reflux disease in infants. In the future, large blinded randomized clinical trials are needed to determine the efficacy and toxicity of metoclopramide in this population.
Topics: Double-Blind Method; Dystonia; Gastroesophageal Reflux; Humans; Infant; Irritable Mood; Metoclopramide; Prospective Studies; Randomized Controlled Trials as Topic; Research Design; Single-Blind Method; Treatment Outcome
PubMed: 16882832
DOI: 10.1542/peds.2005-2664 -
Oncology Nursing Forum Mar 2013To evaluate the effect of ginger as an antiemetic modality for the control of chemotherapy-induced nausea and vomiting (CINV). (Meta-Analysis)
Meta-Analysis Review
PURPOSE/OBJECTIVES
To evaluate the effect of ginger as an antiemetic modality for the control of chemotherapy-induced nausea and vomiting (CINV).
DATA SOURCES
Databases searched included MEDLINE® (PubMed), Embase, CINAHL®, Cochrane Central Register of Controlled Trials, Korean Studies Information Service System, Research Information Sharing Service by the Korean Education and Research Information Service, and Dissertation Central.
DATA SYNTHESIS
A systematic review was conducted of five randomized, controlled trials involving 872 patients with cancer. Ginger was compared with placebo or metoclopramide. The participant characteristics, chemotherapy regimen and antiemetic control, ginger preparation and protocol, measurements, results of the studies, adherence to the treatment protocol, and side effects were reviewed systematically. The incidence and severity of acute and delayed CINV were subject to meta-analysis. The incidence of acute nausea (p = 0.67), incidence of acute vomiting (p = 0.37), and severity of acute nausea (p = 0.12) did not differ significantly between the ginger and control groups.
CONCLUSIONS
Current evidence does not support the use of ginger for the control of CINV. Ginger did not contribute to control of the incidence of acute nausea and vomiting or of the severity of acute nausea.
IMPLICATIONS FOR NURSING
Ginger has long been regarded as a traditional antiemetic modality, but its effectiveness remains to be established. The findings of this study could be incorporated into clinical guidelines, such as the Oncology Nursing Society's Putting Evidence Into Practice resources. Current evidence supports the need for more methodologically rigorous studies in this area.
KNOWLEDGE TRANSLATION
Although ginger is known as a traditional antiemetic, current evidence does not support the effect of ginger in CINV control. The findings of this study inform healthcare providers that its effectiveness remains to be established from methodologically rigorous future trials.
Topics: Antiemetics; Antineoplastic Agents; Zingiber officinale; Humans; Nausea; Neoplasms; Plant Preparations; Vomiting
PubMed: 23448741
DOI: 10.1188/13.ONF.163-170