Ondansetron, ramosetron, or palonosetron: Which is a better choice of antiemetic to prevent postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy?

Abstract

Background:Postoperative nausea and vomiting (PONV) is a serious concern in patients undergoing laparoscopic cholecystectomy (LC), with an incidence of 46 to 72%. The purpose of this study was to compare the antiemetic efficacy of intravenous (iv) ondansetron 8 mg, ramosetron 0.3 mg, and palonosetron 0.075 mg for prophylaxis of PONV in high-risk patients undergoing LC.Materials and Methods:In this prospective, randomized, double-blinded study, 87 female patients, 18 to 70 years of age (ASA I and II) and undergoing elective LC under general anesthesia were randomly allocated into three equal groups, the ondansetron group (8 mg iv; n=29), the ramosetron group (0.3 mg iv; n=29), and the palonosetron group (0.075 mg iv; n=29), and the treatments were given just after completion of surgery before extubation. The incidence of complete response (patients who had no PONV and needed no other rescue antiemetic medication), nausea, vomiting, retching, and need for rescue antiemetics over 24 hours after surgery were evaluated.Results:The number of complete responders were 19 (65.5%) for ramosetron, 11 (37.9%) for palonosetron, and 10 (34.5%) for ondansetron, representing a significant difference overall (P=0.034) as well as between ramosetron and ondansetron (P=0.035). Comparison between ramosetron and palonosetron also showed a clear trend favoring the former (P=0.065).Conclusion:Ramosetron 0.3 mg iv was more effective than palonosetron 0.075 mg and ondansetron 8 mg in the early postoperative period, but there was no significant difference in the overall incidence of nausea suffered.

Palonosetron and Ramosetron Compared for Effectiveness in Preventing Postoperative Nausea and Vomiting: A Systematic Review and Meta-Analysis

“…An additional study, found through a Google search, met the inclusion criteria and was included in this meta-analysis [14]. Thus, eight studies with a total of 695 patients were included in the final systematic review and meta-analysis [14–21] (Fig 1). …”

“…Because several studies defined the early and late phases differently, we combined the various periods of data collection with early and late periods. For the early phase, one study included data collected 0–1 hours [16] postoperatively, one study included data collected 2–6 hours [21] postoperatively, and one study included data collected upon arrival at post-anesthesia care units (PACU)[17]. …”

“…The 5-HT 3 antagonists (palonosetron and ramosetron) were administrated during the early phase of the operation in four studies [14–16,19] and at the end of the surgery in four [17,18,20,21]. …”

“…Palonosetron and ramosetron were compared in six studies [14,15,18–21] for their effectiveness on early, and in four studies for their effectiveness on late [15,18–20] and in seven studies for their effectiveness on overall POV [14–16,18–21]. The combined results did not reveal significance differences between the effectiveness of palonosetron and that of ramosetron in the incidence of early POV (RR 0.75; 95% CI, 0.46 to 1.23; P chi 2 = 0.20; I 2 = 31%; NNTB 36.6; 95% CI, NNTH 50.6 to ∞ to NNTB 13.4), late POV (RR 0.66; 95% CI, 0.39 to 1.14; P chi 2 = 0.84; I 2 = 0%; NNTB 26.1; 95% CI, NNTH 82.3 to ∞ to NNTB 11.3) or overall POV(RR 0.66; 95% CI 0.42 to 1.03; P chi 2 = 0.22; I 2 = 28%; NNTB 22.4; 95% CI, NNTH 495.8 to ∞ to NNTB 10.9).…”

“…Five studies [14,15,17,19,20] assessed the effectiveness of palonosetron and of ramosetron on early and four studies assessed the effectiveness of each drug on late PONV [15,17,19,20] and seven studies on overall PONV [14,15,17–21]. The combined results could not reveal the differences between the effectiveness of palonosetron and that of ramosetron on early PONV (RR 1.07; 95% CI, 0.60 to 1.92; P chi 2 = 0.03; I 2 = 63%; NNT 25.8; 95% CI, NNTH 8.7 to ∞ to NNTB 26.3), late PONV (RR 0.92; 95% CI 0.72 to 1.19; P chi 2 = 0.14; I 2 = 44.4%; NNTB 74.1; 95% CI, NNTH 14.4 to ∞ to NNTB 10.4) or overall PONV (RR 1.23; 95% CI 0.82 to 1.85; P chi 2 = 0.034; I 2 = 56.1%; NNTB 14.4; 95% CI, NNTH 7.2 to ∞ to NNTB 1957.8).…”