Objective  To systematically review the efficacy and safety of dexamethasone in combination with palonosetron as compared to palonosetron alone for the prevention of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery.

Methods  CNKI, WanFang Data, VIP, PubMed, EMbase, the Cochrane Library and Google scholar were electronically searched to collect randomized controlled trials (RCTs) of palonosetron combined with dexamethasone (combination group) versus palonosetron alone (single group) in the treatment of laparoscopic PONV from inception to October 31st, 2021. Two researchers independently screened literature, extracted data, and assessed the risk of bias of the included studies, and meta-analysis was performed using RevMan 5.3 software.

Results  A total of 9 RCTs involving 830 patients were included. The results of meta-analysis showed that the 0-2 h incidence of PONV was significantly lower in the combination group than that in the single group (RR=0.63, 95%CI 0.44 to 0.91, P=0.01), and the 0-24 h incidence of PONV was significantly lower in the combination group than that in the single group (RR=0.61, 95%CI 0.43 to 0.86, P=0.006). The demand rate for antiemetic rescue (RR=0.58, 95%CI 0.41 to 0.84, P=0.004) and the incidence of adverse drug reactions (RR=0.62, 95%CI 0.42 to 0.92, P=0.02) in the combination group were also significantly lower than those in the single group. There were no difference in the incidence of 0-6 h PONV, 2-6 h PONV, 0-48 h PONV, 24-48 h PONV and 0-72 h PONV between the two groups (P>0.05).

Conclusion  Current evidence shows that compared with palonosetron alone, palonosetron combined with dexamethasone can not completely reduce the incidence of PONV after laparoscopic surgery, but it can significantly reduce the need for antiemetic rescue and the incidence of adverse reactions. Due to limited quality and quantity of the included studies, more large-scale, high-quality studies are required to verify above conclusions.

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