Ramosetron, dexamethasone, and their combination for the prevention of postoperative nausea and vomiting in women undergoing laparoscopic cholecystectomy

Background. 5HT3 antagonist, an antiemetic alternative to dexamethasone, is an effective drug for the prevention of postoperative nausea and vomiting (PONV). Methods. PubMed and The Cochrane Library (from inception to June 2016) were searched for relevant RCTs (randomized controlled trials). Results. Seven trials, totaling 682 patients, were included in this meta-analysis. This meta-analysis demonstrated that 5HT3 antagonist was as effective as dexamethasone in preventing PONV (RR, 1.12; 95% CI, [0.86, 1.45]; P = 0.40) within 24 hours of laparoscopic cholecystectomy, and no significant heterogeneity was observed among the studies (I 2 = 0%; P = 0.98). During the early postoperative period (0–6 h), 5HT3 antagonists were superior to dexamethasone in reducing POV (RR, 0.31; 95% CI, [0.11, 0.93]; P = 0.04), while, in other postoperative stages (6–12 h, 12–24 h, and 0–24 h), it was not more effective in the prevention of POV than dexamethasone. And no significant difference was found in the prevention of PON between 5HT3 antagonists and dexamethasone at different postoperative periods (0–6 h, 6–12 h, 12–24 h, and 0–24 h). Conclusions. As a result, it is advisable to encourage 5HT3 antagonists as an alternative to dexamethasone for the prevention of PONV in patients undergoing laparoscopic cholecystectomy.

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“…At last, 7 studies [6–11, 13] were enrolled in this meta-analysis. Figure 1 presents search strategy and study selection.…”

Section: Resultsmentioning

confidence: 99%

5HT3 Antagonists versus Dexamethasone in the Prevention of PONV in Patients Undergoing Laparoscopic Cholecystectomy: A Meta-Analysis of RCTs

Zhou

Zhu

Liu

et al. 2016

BioMed Research International

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“…In addition, the occurrence of nausea during 6-24 hours was 28% for the combination therapy and 41% for the monotherapy, and the occurrence of vomiting was 23% and 35%, respectively, reporting a significant difference. Ramosetron and dolasetron, as well as ondansetron or granisetron, are known to be effective in preventing PONV when used in combination with dexamethasone [14,15]. The mechanism for antiemetic effects remains unclear, but it is postulated that antiemetics inhibit the secretion of prostaglandin synthesis and endogenous opioids, resulting in a central antiemetic effect [11].…”

Section: Discussionmentioning

confidence: 99%

The comparative study to evaluate the effect of palonosetron monotherapy versus palonosetron with dexamethasone combination therapy for prevention of postoperative nausea and vomiting

Park

Jun

Lim

et al. 2012

Korean J Anesthesiol

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Background5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are effective and safe on postoperative nausea and vomiting (PONV). Palonosetron, the newest 5-HT3 antagonist, has potent antiemetic property. We hypothesized that a combination of palonosetron and dexamethasone could more decrease PONV than palonosetron alone.MethodsAmong the patients scheduled to undergo laparoscopic gynecologic surgery, mastoidectomy with tympanoplasty or thyroidectomy under general anesthesia, eighty four female patients with at least two PONV risk factors were enrolled in this study. They were received randomly 0.075 mg palonosetron and 4 mg dexamethasone (group C) or 0.075 mg palonosetron alone (group P). The severity of PONV using Rhodes index and the percentage of complete response during postoperative 24 hours were compared between groups.ResultsThe frequency of mild/moderate/great/severe PONV based on Rhodes index were 9.8%/0%/0%/0% and 9.3%/2.3%/2.3%/0% in group P and group C, respectively. Complete response for PONV was observed in 90.2% and 86% of patients in group P and group C, respectively. The overall incidence of PONV in group P and C was 9.8% and 14%, respectively. There was no significant difference between the two groups.ConclusionsThere were no differences between palonosetron monotherapy and combination therapy of palonosetron and dexamethasone in patients with high emetogenic risk.

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“…In patients at high risk for PONV, the combination therapy using dexamethasone and 5-HT3 antagonists, ondansetron, granisetron, ramosetron as well as dolasetron, appears to be more effective than singledrug prophylaxis. [26][27][28] In a recent study, the ramosetron and dexamethasone combination was found to be superior to ramosetron alone with 93% patients showing complete response at 12-24 hours after laparoscopic cholecystectomy. 27 The dose of dexamethasone used was also chosen based on recommendations of previous studies that addressed its efficacy for treating PONV and postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

“…[26][27][28] In a recent study, the ramosetron and dexamethasone combination was found to be superior to ramosetron alone with 93% patients showing complete response at 12-24 hours after laparoscopic cholecystectomy. 27 The dose of dexamethasone used was also chosen based on recommendations of previous studies that addressed its efficacy for treating PONV and postoperative pain. 23,29 In the current study, a single dose of dexamethasone 8 mg was not related to any adverse effects.…”

Section: Discussionmentioning

confidence: 99%

Effects of palonosetron and dexamethasone on postoperative nausea and vomiting in adult patients undergoing laparoscopic abdominal surgery: a randomized, double-blind, clinical trial at a tertiary care hospital

2016

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Ramosetron, dexamethasone, and their combination for the prevention of postoperative nausea and vomiting in women undergoing laparoscopic cholecystectomy

Abstract: Antiemetic efficacy of the combination of ramosetron 0.3 mg and dexamethasone 8 mg for PONV was most superior, with 93% of the patients showing complete response at 12-24 h after surgery followed by ramosetron alone and dexamethasone alone.

Cited by 27 publications

References 26 publications

5HT3 Antagonists versus Dexamethasone in the Prevention of PONV in Patients Undergoing Laparoscopic Cholecystectomy: A Meta-Analysis of RCTs

5HT3 Antagonists versus Dexamethasone in the Prevention of PONV in Patients Undergoing Laparoscopic Cholecystectomy: A Meta-Analysis of RCTs

The comparative study to evaluate the effect of palonosetron monotherapy versus palonosetron with dexamethasone combination therapy for prevention of postoperative nausea and vomiting

Effects of palonosetron and dexamethasone on postoperative nausea and vomiting in adult patients undergoing laparoscopic abdominal surgery: a randomized, double-blind, clinical trial at a tertiary care hospital

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