Yonsei Med J.  2017 Jul;58(4):848-858. 10.3349/ymj.2017.58.4.848.

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

• Kim MS
• Park JH
• Choi YS
• Park SH
• Shin S

• KMID: 2419094
• DOI: http://doi.org/10.3349/ymj.2017.58.4.848

Abstract

PURPOSE
This study was designed as a meta-analysis of randomized controlled trials (RCTs) that included the comparison of palonosetron and ramosetron for postoperative nausea and vomiting (PONV) prophylaxis.
MATERIALS AND METHODS
A systematic search was conducted for the PubMed, EMBASE, Web of Science, CENTRAL, KoreaMed, and Google Scholar databases (PROSPERO protocol number CRD42015026009). Primary outcomes were the incidences of postoperative nausea (PON) and postoperative vomiting (POV) during the first 48 hrs after surgery. The total 48-hr period was further analyzed in time epochs of 0-6 hrs (early), 6-24 hrs (late), and 24-48 hrs (delayed). Subgroup analyses according to number of risk factors, sex, and type of surgery were also performed.
RESULTS
Eleven studies including 1373 patients were analyzed. There was no difference in PON or POV between the two drugs for the total 48-hr period after surgery. However, palonosetron was more effective in preventing POV during the delayed period overall [relative risk (RR), 0.59; 95% confidence interval (CI), 0.39 to 0.89; p=0.013], as well as after subgroup analyses for females and laparoscopies (RR, 0.56; 95% CI, 0.36 to 0.86; p=0.009 and RR, 0.46; 95% CI, 0.23 to 0.94; p=0.033). Subgroup analysis for spine surgery showed that ramosetron was more effective in reducing POV during the total 48-hr (RR, 3.34; 95% CI, 1.46 to 7.63; p=0.004) and early periods (RR, 8.47; 95% CI, 1.57 to 45.72; p=0.013).
CONCLUSION
This meta-analysis discovered no definite difference in PONV prevention between the two drugs. The significant findings that were seen in different time epochs and subgroup analyses should be confirmed in future RCTs.

Keyword

Palonosetron; ramosetron; postoperative nausea and vomiting

MeSH Terms

Adult
Antiemetics/therapeutic use
Benzimidazoles/*therapeutic use
Female
Humans
Isoquinolines/*therapeutic use
Male
Middle Aged
Postoperative Nausea and Vomiting/chemically induced/*drug therapy/*prevention & control
Publication Bias
Quinuclidines/*therapeutic use
*Randomized Controlled Trials as Topic
Risk Factors
Treatment Outcome
Antiemetics
Benzimidazoles
Isoquinolines
Quinuclidines

Figure

• 

  Fig. 1 Flow chart of the literature screening process.

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  Fig. 2 Forest plot for postoperative vomiting during the early period according to type of surgery. Results of subgroup analysis for laparoscopies, spine surgery and cesarean section (neither a laparoscopy or spine surgery) are shown. RR, relative risk; CI, confidence interval.

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  Fig. 3 Forest plot for postoperative vomiting during the delayed period according to gender. Results of subgroup analysis for studies done only in females and those conducted in both genders are shown. RR, relative risk; CI, confidence interval.

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