Comparison of the Effectiveness of Palonosetron and Ramosetron in Preventing Postoperative Nausea and Vomiting: Updated Systematic Review and Meta-Analysis with Trial Sequential Analysis

This updated systematic review and meta-analysis with trial sequential analysis aimed to compare the efficacy of the perioperative administration of palonosetron with that of ramosetron in preventing postoperative nausea and vomiting (PONV). A total of 17 randomized controlled trials comparing the efficacy of the perioperative administration of palonosetron to that of ramosetron for preventing PONV were included. The primary outcomes were the incidences of postoperative nausea (PON), postoperative vomiting (POV), and PONV, which were measured in early, late, and overall phases. Subgroup analysis was performed on the basis of the administration time of the 5-HT3 receptor antagonist and divided into two phases: early phase and the end of surgery. A total of 17 studies with 1823 patients were included in the final analysis. The incidence of retching (relative risk [RR] = 0.525; 95% confidence interval [CI] = 0.390 to 0.707) and late POV (RR = 0.604; 95% CI = 0.404 to 0.903) was significantly lower in the palonosetron group than in the ramosetron group. No significant differences were demonstrated in the incidence of PON, PONV, complete response, use of antiemetics, and adverse effects. Subgroup analysis showed that palonosetron was superior to ramosetron in terms of early PON, late PON, overall POV, and use of rescue antiemetics when they were administered early; in terms of retching, regardless of the timing of administration. Ramosetron was superior to palonosetron in terms of early PON when they were administered late. The prophylactic administration of palonosetron was more effective than that of ramosetron in preventing the development of retching and late POV. In this meta-analysis, no significant differences in PONV prevention between the two drugs were demonstrated. Further studies are required to validate the outcomes of our study.

Automated summary

This study compared the efficacy of perioperative administration of palonosetron and ramosetron in preventing postoperative nausea and vomiting (PONV). A total of 17 randomized controlled trials were included in the analysis, and the results showed that palonosetron was more effective than ramosetron in reducing vomiting and late vomiting. However, there were no significant differences in nausea, PONV, complete response, use of antiemetics, and adverse effects between the two drugs. Subgroup analysis showed that palonosetron was superior to ramosetron in early PON, late PON, overall POV, and use of rescue antiemetics when administered early, while ramosetron was superior in early PON when administered late. The prophylactic administration of palonosetron was more effective than ramosetron in preventing retching and late POV. No significant differences in PONV prevention were found between the two drugs in this meta-analysis. Further studies are needed to confirm these findings.