Comparison of antiemetic effect of ramosetron with ondansetron in the patients undergoing microvascular decompression with retromastoid craniotomy

Abstract

Background: Microvascular decompression (MVD) with retromastoid craniotomy (RMC) has an especially high risk of postoperative nausea and vomiting (PONV). In this study, we compared the efficacy of ramosetron and ondansetron on PONV in patients undergoing RMC.Methods: Using a balanced anesthesia with sevoflurane in air and remifentanil infusion, ondansetron 8 mg (group O, n = 31) or ramosetron 0.3 mg (group R, n = 31) was administered at the dural closure. The frequency and severity of PONV and required rescue medications and frequency of side effects were measured at post anesthetic care unit (PACU), 6, 24 and 48 hours postoperatively. Independent t-tests and Chi-square test or Fisher’s exact test were used for statistical analyses. Binary logistic regression was used to calculate OR (95% CI). For multiple comparisons, Bonferroni correction was used.Results: There were no differences in demographic data between groups except a slightly longer anesthetic duration of group R (p = 0.01). The overall postoperative 48 hour incidence of nausea and vomiting was 90.3% and 61.3% (group O) and 87.1% and 54.8% (group R), respectively. There were no statistical differences of any measured variables between groups at measured intervals, but patients of group R were in trends of less severe degree of nausea (OR = 0.30; 95% CI, 0.10-0.85; adjusted p = 0.08) and lower incidence of dizziness (OR = 0.34; 95% CI, 0.12-0.96; adjusted p = 0.16) between 6 and 24 hours.Conclusions: The antiemetic efficacy of ramosetron alone was not satisfactory and superior to that of ondansetron in patients undergoing MVD with RMC for at least 48 hours after surgery.