Anesth Pain Med.  2016 Jul;11(3):264-268. 10.17085/apm.2016.11.3.264.

Comparison of the efficacy of ramosetron and palonosetron for prevention of postoperative nausea and vomiting in patients undergoing gynecologic oncology surgery

• Yoon HJ
• Jee YS
• Kim YD

• KMID: 2344929
• DOI: http://doi.org/10.17085/apm.2016.11.3.264

Abstract

BACKGROUND
Postoperative nausea and vomiting (PONV) is a major concern during the post-surgical period. 5-hydroxy-tryptamine (5-HT3) receptor antagonists may be useful for the prevention of PONV. The recently developed 5-HT3 receptor antagonists, ramosetron and palonosetron, have a greater receptor affinity and a longer elimination half-life. This study was designed to assess the efficacy of palonosetron and ramosetron for prevention of PONV in patients receiving intravenous patient-controlled analgesia (IV-PCA) with opioids after gynecological oncology surgery.
METHODS
In this prospective trial, 290 female patients scheduled for elective gynecologic oncology surgery with IV-PCA with opioids were randomized to receive either 0.3 mg ramosetron or 0.075 mg palonosetron intravenously. The occurrence of nausea and vomiting and the use of rescue antiemetics were recorded immediately after the end of surgery, and 0-3 h, 3-24 h, and 24-48 h postoperatively.
RESULTS
The total incidence of PONV was similar between the two groups 0-48 h after surgery, but the incidence of nausea was significantly lower in the ramosetron group 24-48 h postoperatively (11.5% vs. 22.0%, P = 0.036). The incidence of vomiting and the use of rescue antiemetics were not significantly different between the two groups during any of the time intervals. Pain intensity scores and total fentanyl consumption were significantly lower in the ramosetron group 24-48 h postoperatively compared to the palonosetron group (P = 0.021, P = 0.041, respectively).
CONCLUSIONS
The prophylactic effects of ramosetron and palonosetron on PONV incidence in the postoperative 48 h were similar in patients undergoing gynecologic oncology surgery and those receiving opioid-based IV-PCA.

Keyword

Palonosetron; PONV; Ramosetron

MeSH Terms

Analgesia, Patient-Controlled
Analgesics, Opioid
Antiemetics
Female
Fentanyl
Half-Life
Humans
Incidence
Nausea
Postoperative Nausea and Vomiting*
Prospective Studies
Receptors, Serotonin, 5-HT3
Vomiting
Analgesics, Opioid
Antiemetics
Fentanyl
Receptors, Serotonin, 5-HT3

Reference

1. Chandrakantan A, Glass PS. Multimodal therapies for postoperative nausea and vomiting, and pain. Br J Anaesth. 2011; 107(Suppl 1):i27–40. DOI: 10.1093/bja/aer358. PMID: 22156268.

2. Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999; 91:693–700. DOI: 10.1097/00000542-199909000-00022. PMID: 10485781.

3. Roberts GW, Bekker TB, Carlsen HH, Moffatt CH, Slattery PJ, McClure AF. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesth Analg. 2005; 101:1343–8. DOI: 10.1213/01.ANE.0000180204.64588.EC. PMID: 16243992.

4. Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg. 2003; 97:62–71. DOI: 10.1213/01.ANE.0000068580.00245.95. PMID: 12818945.

5. Moon YE, Joo J, Kim JE, Lee Y. Anti-emetic effect of ondansetron and palonosetron in thyroidectomy: a prospective, randomized, double-blind study. Br J Anaesth. 2012; 108:417–22. DOI: 10.1093/bja/aer423. PMID: 22277663.

6. Kim SI, Kim SC, Baek YH, Ok SY, Kim SH. Comparison of ramosetron with ondansetron for prevention of postoperative nausea and vomiting in patients undergoing gynaecological surgery. Br J Anaesth. 2009; 103:549–53. DOI: 10.1093/bja/aep209. PMID: 19700442.

7. Rabasseda X. Ramosetron, a 5-HT3 receptor antagonist for the control of nausea and vomiting. Drugs Today (Barc). 2002; 38:75–89. DOI: 10.1358/dot.2002.38.2.820104.

8. Yang LP, Scott LJ. Palonosetron: in the prevention of nausea and vomiting. Drugs. 2009; 69:2257–78. DOI: 10.2165/11200980-000000000-00000. PMID: 19852528.

9. Roh GU, Yang SY, Shim JK, Kwak YL. Efficacy of palonosetron versus ramosetron on preventing opioid-based analgesia-related nausea and vomiting after lumbar spinal surgery: a prospective, randomized, and double-blind trial. Spine (Phila Pa 1976). 2014; 39:E543–9. DOI: 10.1097/BRS.0000000000000236. PMID: 24480956.

10. Park SK, Cho EJ, Kang SH, Lee YJ, Kim DA. A randomized, double-blind study to evaluate the efficacy of ramosetron and palonosetron for prevention of postoperative nausea and vomiting after gynecological laparoscopic surgery. Korean J Anesthesiol. 2013; 64:133–7. DOI: 10.4097/kjae.2013.64.2.133. PMID: 23459596. PMCID: PMC3581782.

11. Kim SH, Oh CS, Lee SJ. Efficacy of palonosetron and ramosetron on postoperative nausea and vomiting related to intravenous patient-controlled analgesia with opioids after gynecological laparoscopic surgery (double-blinded prospective randomized controlled trial). J Anesth. 2015; 29:585–92. DOI: 10.1007/s00540-015-1981-4. PMID: 25735497.

12. Kim SH, Hong JY, Kim WO, Kil HK, Karm MH, Hwang JH. Palonosetron has superior prophylactic antiemetic efficacy compared with ondansetron or ramosetron in high-risk patients undergoing laparoscopic surgery: a prospective, randomized, double-blinded study. Korean J Anesthesiol. 2013; 64:517–23. DOI: 10.4097/kjae.2013.64.6.517. PMID: 23814652. PMCID: PMC3695249.

13. Park SK, Cho EJ. A randomized, double-blind trial of palonosetron compared with ondansetron in preventing postoperative nausea and vomiting after gynaecological laparoscopic surgery. J Int Med Res. 2011; 39:399–407. DOI: 10.1177/147323001103900207.

14. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 1992; 77:162–84. DOI: 10.1097/00000542-199207000-00023.

15. Candiotti KA, Kovac AL, Melson TI, Clerici G, Joo Gan T. A randomized, double-blind study to evaluate the efficacy and safety of three different doses of palonosetron versus placebo for preventing postoperative nausea and vomiting. Anesth Analg. 2008; 107:445–51. DOI: 10.1213/ane.0b013e31817b5ebb. PMID: 18633022.

16. Chia YY, Kuo MC, Liu K, Sun GC, Hsieh SW, Chow LH. Does postoperative pain induce emesis? Clin J Pain. 2002; 18:317–23. DOI: 10.1097/00002508-200209000-00007. PMID: 12218503.

17. Muchatuta NA, Paech MJ. Management of postoperative nausea and vomiting: focus on palonosetron. Ther Clin Risk Manag. 2009; 5:21–34.

18. Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, Rauch S, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth. 2002; 88:659–68. DOI: 10.1093/bja/88.5.659. PMID: 12067003.

19. Hofer CK, Zollinger A, Büchi S, Klaghofer R, Serafino D, Bühlmann S, et al. Patient well-being after general anaesthesia: a prospective, randomized, controlled multi-centre trial comparing intravenous and inhalation anaesthesia. Br J Anaesth. 2003; 91:631–7. DOI: 10.1093/bja/aeg243. PMID: 14570783.

20. Vari A, Gazzanelli S, Cavallaro G, De Toma G, Tarquini S, Guerra C, et al. Post-operative nausea and vomiting (PONV) after thyroid surgery: a prospective, randomized study comparing totally intravenous versus inhalational anesthetics. Am Surg. 2010; 76:325–8. PMID: 20349666.

21. Apfel CC, Philip BK, Cakmakkaya OS, Shilling A, Shi YY, Leslie JB, et al. Who is at risk for postdischarge nausea and vomiting after ambulatory surgery? Anesthesiology. 2012; 117:475–86. DOI: 10.1097/ALN.0b013e318267ef31. PMID: 22846680.

22. Binning AR, Przesmycki K, Sowinski P, Morrison LM, Smith TW, Marcus P, et al. A randomised controlled trial on the efficacy and side-effect profile (nausea/vomiting/sedation) of morphine-6-glucuronide versus morphine for post-operative pain relief after major abdominal surgery. Eur J Pain. 2011; 15:402–8. DOI: 10.1016/j.ejpain.2010.09.007. PMID: 21041105.

23. Apfel CC, Heidrich FM, Jukar-Rao S, Jalota L, Hornuss C, Whelan RP, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012; 109:742–53. DOI: 10.1093/bja/aes276. PMID: 23035051.

24. Horn CC, Wallisch WJ, Homanics GE, Williams JP. Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting. Eur J Pharmacol. 2014; 722:55–66. DOI: 10.1016/j.ejphar.2013.10.037. PMID: 24495419. PMCID: PMC3915298.

25. Apfel CC. Miller RD, editor. Postoperative nausea and vomiting. Miller’s Anesthesia. 7th ed. Philadelphia: Churchill Livingstone;2010. p. 2729–55. DOI: 10.1016/B978-0-443-06959-8.00086-8.

26. Kenny GN. Risk factors for postoperative nausea and vomiting. Anaesthesia. 1994; 49(Suppl):6–10. DOI: 10.1111/j.1365-2044.1994.tb03576.x. PMID: 8129161.

27. Apfel CC, Stoecklein K, Lipfert P. PONV: a problem of inhalational anaesthesia? Best Pract Res Clin Anaesthesiol. 2005; 19:485–500. DOI: 10.1016/j.bpa.2005.03.001. PMID: 16013696.

28. Kim YY, Song DU, Lee KH, Lee IJ, Song JW, Lim JH. Comparison of palonosetron with ondansetron in preventing postoperative nausea and vomiting after thyroidectomy during a 48-hour period. Anesth Pain Med. 2012; 7:312–6.