Efficacy of esketamine in reducing nausea and vomiting after anesthesia: a systematic review and meta-analysis of randomized controlled trials.
Ling Tang, Shuangquan Qu, Zhen Du et al.
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In 30 seconds
This systematic review and meta-analysis assessed perioperative esketamine for preventing postoperative nausea and vomiting (PONV), drawing on 38 randomized controlled trials involving 3,425 patients. Compared with control, esketamine was associated with lower risks of nausea (RR=0.69, 95% CI: 0.53-0.90) and vomiting (RR=0.75, 95% CI: 0.57-0.98). It also shortened time to first flatus and reduced rescue analgesic needs within 2 days, but prolonged anesthesia recovery and post-anesthesia care unit stay. The authors conclude that potential benefits should be weighed against delayed recovery.
Key findings
- Esketamine reduced nausea risk (RR=0.69, 95% CI: 0.53-0.90) and vomiting risk (RR=0.75, 95% CI: 0.57-0.98).
- Time to first flatus was shorter with esketamine (SMD=-0.81, 95% CI: -1.48 to -0.15).
- Rescue analgesic needs within 2 days decreased (SMD=0.32, 95% CI: 0.2-0.5).
- Anesthesia recovery time and PACU stay were prolonged (SMD=0.97, 95% CI: 0.28-1.67; SMD=0.76, 95% CI: 0.27-1.26).
Why it matters
PONV prevention is an important perioperative outcome, and this synthesis suggests esketamine may reduce both nausea and vomiting while also affecting gastrointestinal recovery and analgesic requirements. The accompanying prolongation of anesthesia recovery and PACU stay highlights a potential trade-off. Considering both benefits and recovery-related outcomes is important when interpreting the evidence on perioperative esketamine.
What to keep in mind
The review reports heterogeneity assessment and sensitivity analyses, but the abstract does not provide details on heterogeneity or the certainty of evidence.