Efficacy of palonosetron for preventing postoperative nausea and vomiting: a systematic review and meta-analysis

Abstract

Purpose Palonosetron, a second-generation 5-hydroxytryptamine 3 receptor antagonist (5-HT 3 RA), has unique characteristics relative to first-generation 5-HT 3 RAs such as ondansetron. Nevertheless, it remains unclear if palonosetron is better than ondansetron for the prevention of nausea and vomiting during the first 24 hr after surgery and is thus the focus of this systematic review. RésuméObjectif Le palonosétron est un antagoniste du récepteur de la 5-hydroxytryptamine 3 (5-HT 3 RA) de deuxième génération; il présente des caractéristiques uniques par rapport aux 5-HT 3 RA de première génération tels que l'ondansétron. Néanmoins, il n'est pas certain que le palonosétron est meilleur que l'ondansétron pour la prévention des nausées et vomissements au cours des 24 premières heures suivant une chirurgie et cela est donc l'objet de cette revue systématique. Méthodes Nous avons effectué une recherche systématique dans les bases de données MEDLINE Ò ,

Comparison of palonosetron and dexamethasone with ondansetron and dexamethasone for postoperative nausea and vomiting in postchemotherapy ovarian cancer surgeries requiring opioid-based patient-controlled analgesia: A randomised, double-blind, active controlled study

“…Our study also correlates well with a systemic review and meta-analysis by Xiong et al . [ 16 ] for comparison of palonosetron and ondansetron for prevention of PONV within 24 hours after surgery. Their primary outcomes were postoperative nausea, postoperative vomiting, or both in early (0–6 hours) or late (0–24 hours) postoperative period.…”

Efficacy of Palonosetron vs. Ramosetron for the Prevention of Postoperative Nausea and Vomiting: A Meta-Analysis of Randomized Controlled Trials

“…There have been recent previous meta-analyses comparing either palonosetron4 or ramosetron323 with ondansetron, but a direct comparison between each other has not yet been made. Xiong, et al4 reported that palonosetron provides better prophylaxis against early PON (0–6 hr), late PON (6–24 hr), and late POV (6–24 hr), compared to ondansetron.…”

“…Xiong, et al4 reported that palonosetron provides better prophylaxis against early PON (0–6 hr), late PON (6–24 hr), and late POV (6–24 hr), compared to ondansetron. However, this analysis did not provide data for time periods after 24 hrs.…”

“…The first 24 hrs after surgery were divided and defined as two different periods: the early and late periods (e.g., 0–6 and 6–24 hrs). However, if the first 24 hrs were divided into three periods, such as 0–2, 2–6, and 6–24 hrs, the second period was defined as the early period, and the third as the late period 4. Also, studies that divided the first 24 hrs into three periods, such that the durations of the first and second period were relatively too short [e.g., 0 to arrival at post-anesthesia care unit (PACU), from arrival to discharge from PACU, from discharge from PACU to 24 hr], the first two periods were combined and defined as the early period.…”

“…Regardless of the type of strategy we choose, however, optimizing a PONV prevention protocol should be based on clinical evidence of the characteristics and comparative efficacies of available drugs. While both palonosetron and ramosetron have been reported to be superior to ondansetron for PONV prevention,34 whether one has better efficacy over the other drug is not clear. In light of the increasing importance of postdischarge nausea and vomiting (PDNV),5 an antiemetic that is effective for durations longer than 24 hours cannot be ignored.…”