Clinical efficacy of 5-hydroxytryptamine 3 receptor antagonists in reducing propofol injection pain, postoperative nausea/vomiting and shivering: A meta-analysis

Objective To investigate the clinical efficacy of 5-hydroxytryptamine 3 (5-HT 3) receptor antagonists in reducing propofol injection pain, postoperative nausea/vomiting, and shivering through pooling the available published data. Methods Prospective randomized clinical studies relevant to 5-HT 3 receptor antagonists in reducing propofol injection pain published before June 2019 were identified from four electronic databases, Pubmed, the Cochrane central register of controlled trials, EMBASE and Wanfang. The incidence of propofol injection pain, postoperative nausea/vomiting, and shivering in patients after 5-HT 3 receptor antagonists were compared to relevant control groups by pooling the individual data through random or fixed-effect models. The publication bias was assessed by funnel plot and Egger's line regression test. Results After screening, a total of 19 publications relevant to 5-HT 3 receptor antagonists in reducing propofol injection pain and prevention of postoperative nausea/vomiting or shivering were included for analysis. The pooled results demonstrated that 5-HT 3 receptor antagonists could significantly reduce the total propofol injection pain compared to placebo (RR=0.49, 95%CI:0.45-0.54, P<0.05). For mild propofol injection pain, there was no statistical difference between 5-HT 3 receptor antagonists and control groups (RR=1.07,95%CI:0.89-1.29, P>0.05). However, for moderate (RR=0.37, 95%CI: 0.31-0.46, P<0.05) and severe (RR=0.19, 95%CI:0.14-0.27, P<0.05) propofol injection pain, the incidence in 5-HT 3 receptor antagonists was significantly lower than that of control groups. The pooled results also indicated that incidence of postoperative nausea/vomiting (RR=0.28, 95%CI:0.17-0.44, P<0.05) and postoperative shivering (RR=0.33, 95%CI:0.23-0.48, P<0.05) were significantly reduced in 5-HT 3 receptor antagonists group compared to control group with a statistical difference. Conclusion: In this meta-analysis, 5-HT 3 receptor antagonists effectively reduced propofol injection pain, postoperative nausea/vomiting, and shivering.