Comparison of the prophylactic anti‐emetic efficacy of ramosetron and ondansetron in patients at high‐risk for postoperative nausea and vomiting after total knee replacement

Abstract

SummaryWe compared the prophylactic anti-emetic efficacy of ramosetron, a newly developed 5-HT 3 antagonist, and ondansetron in patients at high-risk for postoperative nausea and vomiting after total knee replacement. Eighty-four patients with three risk factors for postoperative nausea and vomiting (female, non-smoking and use of postoperative opioid use (ropivacaine and hydromorphone patient controlled epidural analgesia)) undergoing unilateral total knee replacement were randomly allocated to ramosetron 0.3 mg (n = 42) or ondansetron 4 mg (n = 42) groups. A complete response (no postoperative nausea and vomiting and no rescue anti-emetic) and the incidence of postoperative nausea and vomiting were assessed for 48 h after surgery at 0-2 h, 2-6 h, 6-24 h, and 24-48 h. More patients in the ramosetron group had a complete response between 2 and 48 h. The incidence of nausea between 2 and 24 h and the severity of nausea between 2 and 48 h were also less in the ramosetron group. Ramosetron was more effective than ondansetron in preventing postoperative nausea and vomiting in patients at high risk undergoing unilateral total knee replacement.

Preemptive Low-dose Dexamethasone Reduces Postoperative Emesis and Pain After TKA: A Randomized Controlled Study

“…Our findings concur with those of previous studies showing the superior antiemetic effect of concurrent dexamethasone and 5-HT3 antagonist to the 5-HT3 antagonist alone [21,22], but no previous study has investigated the antiemetic efficacy of concomitant dexamethasone and ramosetron after TKA. Two previous studies reported that ramosetron monoprophylaxis after TKA provided a limited antiemetic effect during the 2-to 48-hour or 6-to 48-hour period compared with ondansetron or no prophylaxis [20,27]. Our findings, together with those of previous studies, suggest that prophylaxis with concomitant dexamethasone and ramosetron has a potent antiemetic effect on early PONV which is not provided by ramosetron alone.…”

“…However, as a TKA involves extensive bone resection and soft tissue manipulation, patients can experience severe pain during the early postoperative period [13,42,[47][48][49]. Furthermore, many patients experience postoperative nausea and vomiting (PONV) after TKA, owing to not only anesthesia and surgery but also the various agents used for pain control [8,10,20,27]. Inadequate management of postoperative pain and PONV can lead to several systemic complications and delays recovery [13,16,34,48].…”

Current Review of Ramosetron in the Prevention of Postoperative Nausea and Vomiting

“…Hahm et al demonstrated that ramosetron 0.3 mg administered IV 30 min before the end of surgery was more effective than ondansetron 4 mg for preventing PONV during 0-24 h after anesthesia in 84 women undergoing total knee replacement. The incidence was 18% with ramosetron and 36% with ondansetron [27]. By contrast, ramosetron 0.3 mg administered IV at the end of surgery was as effective as ondansetron 8 mg, and both were more effective than placebo (P < 0.05) for the prevention of PONV during 0-24 h after anesthesia in 162 women undergoing gynecological surgery (PONV: 50% with ramosetron, 44% with ondansetron, and 69% with placebo) [28] and 120 patients (39 men and 41 women) undergoing laparoscopic cholecystectomy (PONV: 10% with ramosetron and 10% with ondansetron) [29].…”

“…Recently, three comparative studies have evaluated the antiemetic efficacy of ramosetron and ondansetron in patients at high risk for PONV [27][28][29]. Hahm et al demonstrated that ramosetron 0.3 mg administered IV 30 min before the end of surgery was more effective than ondansetron 4 mg for preventing PONV during 0-24 h after anesthesia in 84 women undergoing total knee replacement.…”

“…For adult patients, postoperatively, adverse events (AEs), including headache, dizziness, and drowsiness, were found in 12 published articles [14][15][16][17][20][21][22][23][24][25][26][27][28][29]. The most commonly reported adverse effect was headache (5-20%).…”