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

 Min-Soo Kim  ;  Jin Ha Park  ;  Yong Seon Choi  ;  Sang Hun Park  ;  Seokyung Shin 
 YONSEI MEDICAL JOURNAL, Vol.58(4) : 848-858, 2017 
Journal Title
Issue Date
Adult ; Antiemetics/therapeutic use ; Benzimidazoles/therapeutic use* ; Female ; Humans ; Isoquinolines/therapeutic use* ; Male ; Middle Aged ; Postoperative Nausea and Vomiting/chemically induced ; Postoperative Nausea and Vomiting/drug therapy* ; Postoperative Nausea and Vomiting/prevention & control* ; Publication Bias ; Quinuclidines/therapeutic use* ; Randomized Controlled Trials as Topic* ; Risk Factors ; Treatment Outcome
Palonosetron ; postoperative nausea and vomiting ; ramosetron
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.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Min Soo(김민수) ORCID logo https://orcid.org/0000-0001-8760-4568
Park, Jin Ha(박진하) ORCID logo https://orcid.org/0000-0002-1398-3304
Shin, Seokyung(신서경) ORCID logo https://orcid.org/0000-0002-2641-0070
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
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