As compared to 5-HT3-RAs alone, the use of dexamethasone along with 5-hydroxytryptamine 3 receptor antagonists (5-HT3-RAs) offered superior postoperative nausea and vomiting (PONV) prophylactic effects following otologic surgery, as found from a systematic review and meta-analysis by Hsin-Ming Liu et al.

This study was performed with an aim to assess the prophylactic antiemetic outcomes of dexamethasone with 5-HT3-RAs in ear surgery.

Database search on Embase, PubMed and Cochrane Library was done to find the suitable randomized controlled trials with either dexamethasone used alone or along with 5-HT3-RAs for PONV prophylaxis in adults undergoing ear surgery.   Studies lacking a control group of 5-HT3-RA as well as published in languages other than English were excluded from the analysis. The occurrences of early (less than 6 hours) and total (0-48 hours) PONV, need for rescue antiemetics, and adverse events comprised of the main outcome measures.

A total of 8 trials comprising of 733 adults were reviewed, with low risks of bias. In studies comparing early and overall PONV of dexamethasone versus 5-HT3-RAs, the pooled risk ratios (RRs) are displayed in following table 1:

Similarly, RRs in case of combination of dexamethasone and 5-HT3-RAs with 5-HT3-RAs alone have been described in table 2:

Between both the groups, headache and dizziness were commonly described adverse events.

It was observed that during the postoperative phases of ear surgery, there was no significant difference between the prophylactic antiemetic effects of dexamethasone versus 5-HT3-RAs. However, the combination of dexamethasone with 5-HT3-RAs exhibited better postoperative nausea and vomiting prophylactic effects as compared to the 5-HT3-RAs alone where the need for rescue antiemetics remained almost the same for both the groups.