• Emily Au, Karen Zhao, Emilie Belley-Côté, Yuri Song, Waleed Al-Hazzani, Behnam Sadeghirad, Eugene Wang, Jack Young, Hessam Kashani, Morvarid Kavosh, Toru Inami, Chris Beaver, Shelley Kloppenburg, David Mazer, Eric Jacobsohn, Kevin Um, and Jessica Spence.
• Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
• Br J Anaesth. 2024 Mar 1; 132 (3): 469482469-482.

BackgroundDespite recent systematic reviews suggesting their benefit for postoperative nausea, vomiting, or both (PONV) prevention, benzodiazepines have not been incorporated into guidelines for PONV prophylaxis because of concerns about possible adverse effects. We conducted an updated meta-analysis to inform future practice guidelines.MethodsWe included randomised controlled trials (RCTs) of all languages comparing benzodiazepines with non-benzodiazepine comparators in adults undergoing inpatient surgery. Our outcomes were postoperative nausea, vomiting, or both. We assessed risk of bias for RCTs using the Cochrane Risk of Bias tool. We pooled data using a random-effects model and assessed the quality of evidence for each outcome using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.ResultsWe screened 31 413 abstracts and 950 full texts. We included 119 RCTs; 104 were included in quantitative synthesis. Based on moderate certainty evidence, we found that perioperative benzodiazepine administration reduced the incidence of PONV (52 studies, n=5086, relative risk [RR]: 0.77, 95% confidence interval [CI] 0.66-0.89; number needed to treat [NNT] 16; moderate certainty), postoperative nausea (55 studies, n=5916, RR: 0.72, 95% CI 0.62-0.83; NNT 21; moderate certainty), and postoperative vomiting (52 studies, n=5909, RR: 0.74, 95% CI 0.60-0.91; NNT 55; moderate certainty).ConclusionsModerate quality evidence shows that perioperative benzodiazepine administration decreases the incidence of PONV. The results of this systematic review and meta-analysis will inform future clinical practice guidelines.Systematic Review ProtocolThe protocol for this systematic review was pre-registered with PROSPERO International Prospective Register of Systematic Reviews (CRD42022361088) and published in BMJ Open (PMID 31831540).Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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