Efficacy and safety of ramosetron versus ondansetron for postoperative nausea and vomiting after general anesthesia: a meta-analysis of randomized clinical trials

Abstract

BackgroundPostoperative nausea and vomiting is a common side effect of general anesthesia. In this study, we performed a meta-analysis on the efficacy and safety of ramosetron versus ondansetron in the prevention of postoperative nausea and vomiting using the most recently published randomized controlled clinical studies.MethodsPubMed and EMBASE were searched for randomized controlled clinical trials comparing the efficacy and safety of ramosetron and ondansetron. The meta-analysis was performed using Review Manager version 5.3 (Cochrane Collaboration, Oxford, UK). Dichotomous outcomes are presented as the relative risk (RR) with a 95% confidence interval (CI).ResultsA total of 898 patients from nine selected studies were treated with antiemetics after surgery, including 450 patients who received ondansetron 4 mg and 448 patients who received ramosetron 0.3 mg. The meta-analysis showed no statistically significant difference between the two groups with regard to prevention of postoperative nausea (PON) during different time periods in the 48 hours after surgery. When comparing the efficacy of ramosetron and ondansetron in the prevention of postoperative vomiting (POV), at various time intervals in the 24 hours after surgery, ramosetron was significantly more efficient than ondansetron: 0–6 hours (RR 0.46, 95% CI 0.24–0.92; P=0.03), 0–24 hours (RR 0.72, 95% CI 0.52–1.00; P=0.05), and 6–24 hours (RR 0.51, 95% CI 0.31–0.84; P=0.008). At other time periods between 24 and 48 hours after surgery, ramosetron did not show better efficacy than ondansetron. When comparing the safety profiles of ramosetron and ondansetron, fewer side effects were recorded in the ramosetron group (RR 0.65, 95% CI 0.47–0.91; P=0.01).ConclusionOur meta-analysis demonstrates that ramosetron was more effective than ondansetron in the prevention of early POV (0–24 hours) with fewer recorded side effects. However, our study did not reveal any statistically significant differences in efficacy between ramosetron and ondansetron in the prevention of PON or late POV (at 24–48 hours).

Comparative efficacy of ramosetron and ondansetron in preventing postoperative nausea and vomiting: An updated systematic review and meta-analysis with trial sequential analysis

“…Previously, we reported results of the meta-analysis of the effects of ramosetron in preventing PON and POV [ 3 ]; the combined results with 637 patients (six studies) showed that ramosetron had a statistically significant effect on early POV (risk ratio [95% confidence interval] = 0.50 [0.28–0.90]) and late POV (0.53 [0.34–0.81]) but not early PON (0.79 [0.51–1.23]) and late PON (0.78 [0.60–1.46]) compared with 4 mg of ondansetron. Although ramosetron was reported to be more effective than ondasetron in preventing POV [ 3 , 4 ], an updated meta-analysis is required because several randomized controlled trials (RCTs) have been published since then. The Cochrane Handbook recommends that systematic reviews be updated within two years, because “systematic reviews that are not maintained may become out of date or misleading” [ 5 ].…”

“…The Cochrane Handbook recommends that systematic reviews be updated within two years, because “systematic reviews that are not maintained may become out of date or misleading” [ 5 ]. In addition, these previous studies [ 3 , 4 ] looked only at RCTs which prescribed 4 mg of ondansetron. Ryu et al reported that 8 mg of ondansetron were equally as effective as ramosetron in preventing PONV [ 6 ].…”

Anti-emetic Drugs for Prophylaxis of Postoperative Nausea and Vomiting After Craniotomy: An Updated Systematic Review and Network Meta-Analysis

“…These results are consistent with a previous meta-analysis in which ramosetron was found to be more effective for PONV with fewer side effects in comparison with ondansetron. Aprepitant showed no statistically significant differences in reducing PON incidence (25). Secondly, fosaprepitant appeared to be the most effective prophylactic medication for POV, both between 0-24 and 0-48 h postoperatively.…”

Comparison of ramosetron and ondansetron for the treatment of established postoperative nausea and vomiting after laparoscopic surgery: a prospective, randomized, double-blinded multicenter trial

“…In a recent meta-analysis comparing ramosetron to ondansetron for preventing PONV during various types of surgery, there was no difference in incidence of nausea, need for rescue antiemetics, and incidence of side effects, but there was significantly less vomiting in patients receiving ramosetron during early (0–6 h) and late (6–24 h) time periods. 14 – 16 In this study, we had expected that ramosetron would have an advantage over ondansetron in treating vomiting or preventing further retching or vomiting in the late period because differences exist in receptor affinity, pharmacokinetics, and the half-life between ramosetron and ondansetron (9 vs 3.5 h, respectively). 17 Although differences did not reach statistical significance, 53% of patients receiving ramosetron treatment were prevented from further retching or vomiting without secondary rescue antiemetic administration compared to 44% of patients receiving ondansetron treatment.…”