Ramosetron Group Research Articles

Randomized Trial Study on Ramosetron and Dexamethasone in the Prevention of Nausea and Vomiting after Laparoscopic Cholecystectomy under General Anesthesia

objective: this study aims to identify whether dexamethasone can be used in the prevention of nausea and vomiting after laparoscopic cholecystectomy (LC) under general anesthesia. Methods: 400 patients who were performed with LC under general anesthesia were chosen and divided randomly into two groups with 200 patients each, namely ramosetron group and dexamethasone group. Results: there’s no significant difference in the effectiveness of complete inhibition of nausea and vomiting within 24 hours after the surgery in both groups (P> 0.050). Meanwhile, there’s no significant side effects in association with the anti-emetic drugs within 24 hours after the operation in both groups, either. Conclusion: Dexamethasone plays a similar effective role as Ramosetron in the prevention of nausea and vomiting after laparoscopic cholecystectomy under general anesthesia.

A Comparative Evaluation of Ramosetron with Ondansetron for the Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Urological Procedures.

Background:Postoperative nausea and vomiting (PONV) is a common problem causing distress to patients in the postoperative period. Younger age, gynecological surgeries, laparoscopic surgeries, female gender, volatile anesthetics, increased duration of anesthesia, and postoperative opioid use are associated with increased incidence of PONV.Aim:The present study was conducted to study the efficacy of ramosetron and its comparison with ondansetron in the prevention of PONV in patients undergoing pyelolithotomy, pyeloplasty, and upper ureterolithotomy.Methods:One hundred patients with physical status American Society of Anesthesiologists I and II, aged 20–60 years were enrolled in the study. Patients were randomly distributed to receive either injection ramosetron 0.3 mg intravenously (IV) or injection ondansetron 6 mg IV just before extubation.Results:There was no significant difference between the groups in age, gender, weight, duration of anesthesia, and duration of surgery. In the patients, who received ramosetron, it was observed that incidence of the episodes of nausea and vomiting increased with time after surgery. Each patient had an episode of nausea and an episode of vomiting during the 6–12 h interval. Similarly, two patients had episodes of nausea and two patients had episodes of vomiting at 18–24 h. This necessitated the increased need for rescue antiemetics with a total of four patients needing rescue antiemetics at 18–24 h. In patients receiving ondansetron, the episodes of nausea were more in number when compared with the ramosetron group. Twelve patients complained of nausea and thirteen patients had episodes of vomiting with the needfor rescue antiemetic in 14 patients. Both genders had a comparable incidence of nausea and vomiting.Conclusion:A single dose of IV ramosetron (0.3 mg) is more effective when compared with a single dose IV ondansetron (6 mg) in the prevention of PONV. We observed that the benefit was more in the later stages of the postoperative period (12–24 h).

Comparing combination antiemetics of ramosetron and dexamethasone to ondansetron and dexamethasone in middle ear surgery in high risk patients: a prospective, randomized double-blind clinical study

Context: Combination antiemetics are recommended as prophylaxis for PONV in moderate to high risk patients. Commonly dexamethasone and 5 HT3 receptor antagonists are used as combination antiemetics. There is questionable benefit of adding dexamethasone to ramosetron for PONV prophylaxis. There are no studies comparing efficacy of combination of dexamethasone with single dose of ondansetron and ramosetron. Aims: To evaluate the efficacy of ramosetron and dexamethasone combination and compare it with ondansetron and dexamethasone in preventing PONV after middle ear surgery under general anaesthesia, in patients who are moderate to severe risk of PONV. Settings and Design: Peri-operative and up to 48 hours postoperative. Prospective, randomised, double blind study. Methods and Material: One hundred and forty four adult patients undergoing middle ear surgeries were allocated to receive either dexamethasone 8 mg and ondansetron 4 mg (n = 72) or dexamethasone 8mg and ramosetron 0.3 mg (n = 72). The incidence and severity of PONV, need of rescue antiemetics and the side effects of the antiemetics were noted for the first 48 h after surgery. Statistical analysis used: Chi-square test or Fisher’s exact test, independent sample t-test. Results: There was no significant difference in the incidence and severity of nausea between groups at 2, 2-12, 12-24 and 24-48 hour interval. The incidence of vomiting and use of rescue antiemetic was also not different between groups at all the time intervals. Percentage of patients with no PONV in 48 hours was 78% and 76% in dexamethasone ondansetron and dexamethasone ramosetron groups respectively. Conclusions: Combination of dexamethasone and ramosetron has equal efficacy as ondansetron with dexamethasone in reducing PONV after middle ear surgery. Key-words: Postoperative nausea and vomiting, Middle ear surgery, Ondansetron, Ramosetron, Dexamethasone. Key Message: Combination of dexamethasone and ramosetron has equal efficacy as

Effect of total intravenous anaesthesia and prophylactic ramosetron on postoperative nausea and vomiting after thyroidectomy: A prospective, randomized controlled study.

ObjectiveTo investigate the effect of combined prophylactic ramosetron and total intravenous anaesthesia (TIVA) on postoperative nausea and vomiting (PONV), compared with sevoflurane anaesthesia without prophylactic antiemetics, in female patients undergoing thyroidectomy.MethodsFemale patients were randomized between the sevoflurane group (anaesthesia maintained with sevoflurane) or TIVA + ramosetron group (TIVAR; 0.3 mg ramosetron just before anaesthesia induction, remifentanil and propofol anaesthesia). Incidence and severity of PONV and use of rescue antiemetics were recorded during the first 24 h after surgery.ResultsIn the early postoperative period (0–6 h), the incidence of PONV, severe emesis and rescue antiemetic use were significantly lower in the TIVAR group (n = 36) than in the sevoflurane group (n = 36). In the late postoperative period (6–24 h), the incidence of severe emesis was significantly lower in the TIVAR group than in the sevoflurane group.ConclusionsA combination of TIVA and prophylactic ramosetron decreases early PONV and late postoperative severe emesis compared with sevoflurane anaesthesia.

Effect of ramosetron on QTc interval: a randomised controlled trial in patients undergoing off-pump coronary artery bypass surgery.

BackgroundRamosetron is a relatively new 5-hydroxytryptamine three receptor antagonist with higher binding affinity and more prolonged duration of action compared to ondansetron. The present study was performed to evaluate the effects of ramosetron on QTc interval and possible cardiovascular adverse effects in patients undergoing cardiac surgery.MethodA total of 114 patients who underwent off-pump coronary artery bypass surgery were enrolled in this randomised placebo-controlled trial. Patients were allocated into two groups that received intravenous injection of 0.3 mg ramosetron or normal saline during induction of anaesthesia. QTc intervals were measured before the operation, intraoperatively (0, 1, 2, 3, 5, 10, 15, 30, 45, 60, 90, 120, and 240 min after injection of ramosetron or normal saline), at the end of the operation, and on postoperative day 1.ResultsThere were no differences in mean QTc interval between groups at every time point. However, maximal change in QTc interval during surgery was higher in the ramosetron group than the placebo group (25.1 ± 22.0 vs. 17.5 ± 14.5 ms, 95 % CI 0.34–14.78, P = 0.040). Also, there were more patients with a QTc interval increase of > 60 ms in the ramosetron group (5 vs. 0, 95 % CI 1.6–18.0, P = 0.021). There were no significant differences in cardiovascular complications.ConclusionsRamosetron administered during induction of anaesthesia may affect maximal change in QTc interval during off-pump coronary artery bypass surgery. Ramosetron should be used with caution in high risk patients for developing Torsades de Pointes.Trial registrationClinicalTrials.gov NCT02139241. Registered November 12, 2013Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0222-1) contains supplementary material, which is available to authorized users.

Ramosetron Reduces Symptoms of Irritable Bowel Syndrome With Diarrhea and Improves Quality of Life in Women

Previous studies have indicated that serotonin-3-receptor antagonists might have a sex-specific effect in patients with irritable bowel syndrome with diarrhea (IBS-D). Alosetron has been approved for the treatment of only women, and ramosetron has been approved for the treatment for only men. We performed a randomized, placebo-controlled, phase 3 study to determine whether ramosetron reduces symptoms of IBS-D in women. We performed a prospective study of 576 female outpatients with IBS-D (according to the Rome III criteria), from February 2013 through February 2014, at 70 academic Gastroenterology Departments in Japan. After a 1-week baseline period, subjects received either 2.5 μg ramosetron (n = 292) or placebo (n = 284) once daily for 12 weeks. Primary end points were the monthly rates of response for relief from overall IBS symptoms and increased stool consistency at the last evaluation point. Quality of life (QOL) also was quantified. A significantly higher proportion of patients given ramosetron reported global improvement (50.7%; 95% confidence interval [CI], 44.8-56.6) than patients given placebo (32.0%; 95% CI, 26.7-37.8)--a difference of 18.6% (95% CI, 10.7-26.5; P < .001). The relative risk was 1.58 (95% CI, 1.29-1.94) and the number needed to treat was 6 (95% CI, 4-10). A significantly higher proportion of patients in the ramosetron group reported increased stool consistency (40.8%; 95% CI, 35.1%-46.6%) than in the placebo group (24.3%; 95% CI, 19.4%-29.7%)--a difference of 16.5% (95% CI, 8.9%-24.0%; P < .001). Patients receiving ramosetron had significant reductions in abdominal pain and discomfort (P = .001) and greater improvement in QOL (P = .002) compared with placebo. Ramosetron induced constipation in 11.0% of patients. In a randomized, placebo-controlled study of 576 women with IBS-D, 2.5 μg ramosetron per day reduced symptoms and increased stool consistency and QOL. Clinicaltrials.gov no: NCT01870895.

Comparison of ramosetron plus dexamethasone with ramosetron alone on postoperative nausea, vomiting, shivering and pain after thyroid surgery.

BackgroundPostoperative nausea and vomiting (PONV), postanesthetic shivering and pain are common postoperative patient complaints that can result in adverse physical and psychological outcomes. Some antiemetics are reported to be effective in the management of postoperative pain and shivering, as well as PONV. We evaluated the efficacy of dexamethasone added to ramosetron on PONV, shivering and pain after thyroid surgery.MethodsOne hundred and eight patients scheduled for thyroid surgery were randomly allocated to three different groups: the control group (group C, n = 36), the ramosetron group (group R, n = 36), or the ramosetron plus dexamethasone group (group RD, n = 36). The patients were treated intravenously with 1 and 2 ml of 0.9% NaCl (group C); or 2 ml of 0.15 mg/ml ramosetron plus 1 ml of 0.9% NaCl (group R); or 2 ml of 0.15 mg/ml ramosetron plus 1 ml of 5 mg/ml dexamethasone (group RD) immediately after anesthesia.ResultsIncidence of nausea and the need for rescue antiemetics, verbal rating scale (VRS) 1 hour pain value, ketorolac consumption, and incidence of shivering were significantly lower in group R and group RD, than in group C (P < 0.05). Moreover, these parameters were significantly lower in group RD than in group R (P < 0.05).ConclusionsCombination of ramosetron and dexamethasone significantly reduced not only the incidence of nausea and need for rescue antiemetics, but also the VRS 1 hour pain value, ketorolac consumption, and the incidence of shivering compared to ramosetron alone in patients undergoing thyroid surgery.

Comparison of ramosetron with ondansetron for the prevention of post-operative nausea and vomiting in high-risk patients.

Background and Aims:Post-operative nausea and vomiting (PONV) has an 80% incidence in high-risk patients. This is despite the availability of several antiemetic drugs. Selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are considered first-line for prophylaxis, ondansetron being the most commonly used agent. Ramosetron, another selective 5-HT3 receptor antagonist, is more potent and longer acting than ondansetron. This study was conducted to evaluate the antiemetic efficacy of ramosetron in comparison with ondansetron in patients at a high risk of PONV.Methods:This was a prospective randomised double-blind study carried out over a 6-month period in which 206 patients with at least two risk factors for PONV were randomised to receive ramosetron 0.3 mg or ondansetron 8 mg, 30 min before the end of surgery. The incidence of PONV, severity of nausea and need for rescue antiemetic were recorded over the next 24 h. Primary outcome was the incidence of PONV. Secondary outcomes included severity of nausea and need for rescue. The data were analysed using the Predictive Analytics Software (PASW, version 18: Chicago, IL, USA).Results:The incidence of PONV was found to be 35% in the ramosetron group as opposed to 43.7% in the ondansetron group (P = 0.199). Need for rescue antiemetic was 23.3% in the ramosetron group and 32% in the ondansetron group (P = 0.156) in the 24 h following surgery.Conclusion:Ramosetron 0.3 mg and ondansetron 8 mg were equally effective in reducing the incidence of PONV in high risk patients.

Comparison of the Efficacy of Ramosetron and Ondansetron in the Prophylaxis of Postoperative Vomiting in Children Receiving Fentanyl by Patient-Controlled Analgesia After Orthopedic Surgery

Park, Yo-Hee; Jang, Young-Eun; Byon, Hyo-Jin; Kim, Jin-Tae; Kim, Hee-Soo Author Information

Efficacy of Palonosetron Versus Ramosetron on Preventing Opioid-Based Analgesia-Related Nausea and Vomiting After Lumbar Spinal Surgery

A prospective, randomized, and double-blind study. To compare the efficacy of ramosetron and palonosetron on preventing postoperative nausea and vomiting (PONV) associated with opioid-based intravenous patient-controlled analgesia (IV-PCAopioid) after lumbar spinal surgery. IV-PCAopioid, an effective method to control pain after lumbar spinal surgery, accompanies PONV. Ramosetron and palonosetron are novel 5-hydroxytryptamine 3 antagonists known to have longer action duration and higher receptor affinity than their congeners, whereas their relative efficacy has not been validated yet. One hundred ninety-six patients were randomly and evenly allocated to receive either 0.3 mg of ramosetron or 0.075 mg of palonosetron 10 minutes before the end of operation. Ramosetron or palonosetron were also added to the IV-PCAopioid, which was continuously infused for 48 hours postoperatively. The incidence and intensity of PONV were serially assessed for 72 hours postoperatively. Intensity of pain, volume of IV-PCAopioid consumption, use of rescue analgesics and antiemetics, and adverse events were also assessed. The overall incidence of PONV was lower in the ramosetron group than the palonosetron group (50% vs. 67%, P = 0.014) without any intergroup difference in the incidence of vomiting. Nausea intensity scores were also lower until 6 (P = 0.041) and 24 hour (P = 0.026) postoperatively in the ramosetron group than the palonosetron group. Pain intensity scores were significantly lower in the ramosetron group than the palonosetron group for 72 hours postoperatively. Ramosetron was superior to palonosetron in term of reducing the incidence and severity of nausea associated with IV-PCAopioid after lumbar spinal surgery. This favorable influence of ramosetron on PONV was translated to significant postoperative pain reduction compared with palonosetron. 1.

Ramosetron hydrochloride for the prevention of cancer chemotherapy induced nausea and vomiting: The Indian experience.

Background:Despite the advent of 5-HT3 antagonists, control of delayed gastrointestinal adverse events with cancer chemotherapy is still not optimal. This open label, active controlled, multicentric clinical trial was undertaken to assess the comparative efficacy and safety of ramosetron with ondansetron for the prevention of acute and delayed nausea and vomiting associated with emetogenic cancer chemotherapy in adult patients in India.Materials and Methods:Enrolled patients received treatment with ramosetron hydrochloride 0.1 mg or ondansetron hydrochloride 4 mg tablets once daily in the morning for 5 days starting 1 h before the start of chemotherapy. Severity grades of nausea and vomiting were recorded on a daily basis for a period of 5 days and complete response rate (CRR) and effective rate (ER) were calculated. Clinical adverse events were recorded and hematological and biochemical investigations were performed for safety assessment.Results:A total of 114 patients in ramosetron group and 100 patients in ondansetron group completed the study and were eligible for efficacy and safety analysis. CRR and ERs show that while ramosetron is non-inferior to ondansetron in the control of early nausea and vomiting (occurring during the first 24 h) after the treatment with emetogenic chemotherapy, it is superior to ondansetron in the control of delayed nausea and vomiting (occurring after the first 24 h). The proportion of patients achieving a cumulative complete response (for the entire study period) is significantly greater in ramosetron group as compared to ondansetron group (27.2% vs. 7.0%; P < 0.001). Ramosetron was well tolerated by all the study participants.Conclusions:Ramosetron is significantly more effective than ondansetron for the control of delayed nausea and vomiting induced by emetogenic cancer chemotherapy.

The Influence of Ramosetron on the Analgesic Effect of Tramadol

Background: The 5-hydroxytryptamine-3 antagonist antiemetics block the analgesic effect of tramadol. This prospective, randomized single-blinded study was designed to investigate the interaction between ramosetron and tramadol in females undergoing thyroidectomy. Method: We randomized 128 patients into two groups to receive ramosetron-tramadol (group R) or normal saline-tramadol (group N). Intravenous ramosetron (0.3 mg) or normal saline was administered at the induction of anesthesia, and 50 mg tramadol were given intravenously for postoperative analgesia 30 min before extubation. The analgesic regimen in the post-anesthesia care unit included additional 50 mg doses of tramadol if pain scores were >40 at rest. Postoperative pain was evaluated using an 11-point visual analog scale at 1 and 24 h postoperatively. Pain and nausea scores, analgesic and antiemetic doses, side effects, patient satisfaction with pain management, and postoperative nausea and vomiting were recorded 1 and 24 h after surgery. Results: The control group received 169.67 ± 46.80 mg tramadol vs. 168.33 ± 46.9 mg in the ramosetron group during the first 24 h after surgery (p=0.875). Total antiemetic dose was significantly lower in the ramosetron group than that in the control (p=0.012). Conclusions: We found that 0.3 mg ramosetron administered at the induction of anesthesia did not reduce the antinociceptive properties of tramadol.

Multicenter nonrandomized trial of ramosetron versus palonosetron in controlling chemotherapy-induced nausea and vomiting for colorectal cancer.

PurposeChemotherapy-induced nausea and vomiting (CINV) have a negative impact on patients' quality of life and frequently pointed to as a major factor for treatment abandonment. Serotonin (5-HT3) receptor antagonist is considered as key treatment for CINV. Ramosetron and palonosetron are recently developed 5-HT3 receptor antagonists and known as more superior than other first-generation 5-HT3 receptor antagonists. The purpose of this study was to compare the efficacy of ramosetron and palonosetron and determine which drug is more effective for prevention of CINV.MethodsColorectal cancer patients treated with chemotherapy were enrolled consecutively. Patients were assigned to receive intravenous injection of ramosetron 0.3 mg or palonosetron 0.25 mg at 30 minutes before initiation of moderately emetogenic chemotherapy. Ramosetron group added oral administration of 0.1 mg ramosetron on the second and third days of chemotherapy. Efficacy parameter consisted of nausea and vomiting.ResultsNinety-one patients received ramosetron and 89 patients received palonosetron. Presentation of vomiting and nausea symptoms was not significantly different between the two groups during acute (0-24 hours) and delayed period (after 24 hours).ConclusionThe incidence of CINV between the ramosetron and the palonosetron group has not shown any difference during acute, delayed, and overall period.

Effect of Ramosetron on Stool Consistency in Male Patients With Irritable Bowel Syndrome With Diarrhea

Ramosetron, a serotonin (5-hydroxytryptamine)-3 receptor antagonist with high selectivity, reduced stress-induced diarrhea and defecation caused by corticotropin-releasing hormone in rats. However, there have been no clinical trials of its effect in patients with diarrhea and irritable bowel syndrome (IBS-D). We performed a randomized, double-blind, placebo-controlled trial to determine whether ramosetron reduces diarrhea in these patients. Our study included 296 male outpatients with IBS-D treated at 52 centers in Japan. Patients were given 5 μg oral ramosetron (n= 147) or placebo (n= 149) once daily for 12 weeks after a 1-week baseline period. The primary end point was increased stool consistency in the first month. Secondary end points included relief of overall IBS symptoms and increased IBS-related quality of life. More patients given ramosetron (74, 50.3%) than those given placebo (29, 19.6%) reported improved stool consistency in the first month (P < .001). The relative risk and number needed to treat were 2.57 (95% confidence interval, 1.79-3.70) and 3.25 (95% confidence interval, 2.44-4.89), respectively. The ramosetron group had significantly higher monthly rates of relief of overall IBS symptoms and IBS-related quality of life than the placebo group. Ramosetron (5 μg oral, once daily for 12 weeks) improved stool consistency in male patients with IBS-D, compared with placebo. These study results, along with the pharmacologic profile of ramosetron, indicate that increased stool consistency is the best end point for studies of ramosetron in patients with IBS-D. Clinicaltrials.gov No, NCT01225237.

Effects of Ramosetron on Gastrointestinal Transit of Guinea Pig

Background/AimsA selective 5-hydroxytryptamine (5-HT) type 3 receptor antagonist, ramosetron, inhibits stress-induced abnormal defecation in animals and is currently used as a therapeutic drug for irritable bowel syndrome with diarrhea. The aim of this study is to investigate the effect of ramosetron on altered gastrointestinal (GI) transit.MethodsMale guinea pigs weighing approximately 300 g were used. The effect of ramosetron was investigated on altered GI transit induced by thyrotropin-releasing hormone (TRH), 5-HT, or mustard oil (MO). GI transit was evaluated by the migration of charcoal mixture from the pylorus to the most distal point, and expressed as a percentage (%) of charcoal migration (cm) of the total length of total small intestine (cm).ResultsThe average charcoal transit was 51.3 ± 20.1% in the control (vehicle) group, whereas in the ramosetron group charcoal moved 56.6 ± 21.9%, 46.9 ± 9.14% and 8.4 ± 5.6% of the total small intestine at the concentrations of 10, 30 and 100 µg/kg, respectively. GI transit after administration of TRH (100 µg/kg), 5-HT (10 mg/kg) or MO (10 mg/kg) was accelerated compared to vehicle (5-HT, 94.9 ± 9.22%; TRH, 73.4 ± 14.7%; MO, 81.0 ± 13.7%). Ramosetron inhibited GI transit altered by 5-HT, TRH or MO.ConclusionsRamosetron modulated GI transit. We suggest that ramosetron may be therapeutically useful for those with accelerated upper GI transit.

Comparison of the efficacy of ramosetron and ondansetron in the prophylaxis of postoperative vomiting in children receiving fentanyl by patient‐controlled analgesia after orthopedic surgery: a randomized controlled trial

This study was designed to compare the efficacy of prophylactic ramosetron and ondansetron in preventing postoperative vomiting in children who received fentanyl by patient-controlled analgesia after orthopedic surgery. Two hundred and eighteen children, 2-15years old, ASA physical status 1 or 2, scheduled for elective orthopedic surgeries, were randomly divided into the ramosetron group (n=109) or ondansetron group (n=109). Patients in ondansetron group received ondansetron 100μg·kg(-1) and patients in ramosetron group received ramosetron 6μg·kg(-1) after surgery. Intravenous patient-controlled analgesia with fentanyl was used in both groups. The incidence of postoperative vomiting and side effects were assessed during the 48h after surgery. There was significantly less vomiting during the first 24-h and 6-24-h period after surgery in ramosetron group than in ondansetron group (P<0.01). There were no significant differences in side effect of 5-HT(3) antagonist between the two groups. Ramosetron was more effective during the first 24-h period after surgery than ondansetron in children using fentanyl patient-controlled analgesia after general anesthesia.

A randomized, double-blind study to evaluate the efficacy of ramosetron and palonosetron for prevention of postoperative nausea and vomiting after gynecological laparoscopic surgery

BackgroundPostoperative nausea and vomiting (PONV) is a common complication after anesthesia and surgery; 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists have been considered as a first-line therapy. Ramosetron and palonosetron are more recently developed drugs and have greater receptor affinity and a longer elimination half-life compared with older 5-HT3 receptor antagonists. The purpose of this study was to determine which drug is more effective for preventing PONV between ramosetron and palonosetron.MethodsWe enrolled 100 patients undergoing gynecological laparoscopic surgery into this study. The subjects were divided into ramosetron group and palonosetron group. The medications were provided immediately before the induction of anesthesia. The occurrence of nausea and vomiting, severity of nausea according to a visual analogue scale, and rescue anti-emetic drug use were monitored immediately after the end of surgery and at 0-6 h, 6-24 h, and 24-48 h post-surgery.ResultsThe incidence of vomiting was significantly lower in the palonosetron group than in the ramosetron group during 0-6 h (6% vs 26%, P = 0.012) and 0-48 h (14% vs 34%, P = 0.034). The incidence of nausea and overall PONV, and the use of rescue antiemetic were not significantly different during all time intervals. The severity of nausea was not different between the two groups.ConclusionsIn conclusion, the incidence of PONV between the ramosetron and the palonosetron group have not shown the difference during 0-48 h, although palonosetron results in a lower incidence of vomiting during 0-6 h post-surgery.

Palonosetron has superior prophylactic antiemetic efficacy compared with ondansetron or ramosetron in high-risk patients undergoing laparoscopic surgery: a prospective, randomized, double-blinded study

BackgroundPostoperative nausea and vomiting (PONV) continues to be a major problem, because PONV is associated with delayed recovery and prolonged hospital stay. Although the PONV guidelines recommended the use of 5-hydroxy-tryptamine (5-HT3) receptor antagonists as the first-line prophylactic agents in patients categorized as high-risk, there are few studies comparing the efficacies of ondansetron, ramosetron, and palonosetron. The aim of present study was to compare the prophylactic antiemetic efficacies of three 5HT3 receptor antagonists in high-risk patients after laparoscopic surgery.MethodsIn this prospective, randomized, double-blinded trial, 109 female nonsmokers scheduled for elective laparoscopic surgery were randomized to receive intravenous 4 mg ondansetron (n = 35), 0.3 mg ramosetron (n = 38), or 75 µg palonosetron (n = 36) before anesthesia. Fentanyl-based intravenous patient-controlled analgesia was administered for 48 h after surgery. Primary antiemetic efficacy variables were the incidence and severity of nausea, the frequency of emetic episodes during the first 48 h after surgery, and the need to use a rescue antiemetic medication.ResultsThe overall incidence of nausea/retching/vomiting was lower in the palonosetron (22.2%/11.1%/5.6%) than in the ondansetron (77.1%/48.6%/28.6%) and ramosetron (60.5%/28.9%/18.4%) groups. The rescue antiemetic therapy was required less frequently in the palonosetron group than the other groups (P < 0.001). Kaplan-Meier analysis showed that the order of prophylactic efficacy in delaying the interval to use of a rescue emetic was palonosetron, ramosetron, and ondansetron.ConclusionsSingle-dose palonosetron is the prophylactic antiemetics of choice in high-risk patients undergoing laparoscopic surgery.

Comparison of the antiemetic effect of ramosetron with the combination of dexamethasone and ondansetron in middle ear surgery: A double-blind, randomized clinical study

Background:Postoperative nausea and vomiting (PONV) is a frequent complication of middle ear surgery. Ondansetron has been shown to be effective for early PONV and dexamethasone has been shown to be effective for late PONV. Therefore, a combination of dexamethasone and ondansetron is commonly used for middle ear surgery. This study was conducted to compare the combination of ondansetron and dexamethasone with ramosetron for early and late PONV up to 48 h after middle ear surgery.Methods:One hundred and twenty adults scheduled for middle ear surgery were allocated to receive either dexamethasone 8 mg and ondansetron 4 mg (n=60) or ramosetron 0.3 mg (n=60). General anesthesia with inhalation agents was used for all the patients. The incidence and severity of PONV, administration of rescue antiemetic, and the side effects of the antiemetic were documented during the first 48 h after surgery.Results:The incidence of nausea was significantly lower in the dexamethasone and ondansetron group compared to the ramosetron group between 2 and 24 h. The complete response, which is patients with no nausea or vomiting, was significantly more in dexamethasone and ondansetron group compared to ramosetron group between 2 and 24 h and between 24 and 48 h (76% vs. 56%, P=0.02, 93% vs. 81%, P=0.05, respectively). Overall, complete response was more in dexamethasone and ondansetron group compared to ramosetron group (71% vs. 40%, P=0.01).Conclusion:The combination of dexamethasone and ondansetron is superior to ramosetron for prevention of PONV after middle ear surgeries.

Effects of ramosetron and dexamethasone on postoperative nausea, vomiting, pain, and shivering in female patients undergoing thyroid surgery

Some antiemetics are effective in the treatment of postoperative pain and shivering, as well as for postoperative nausea and vomiting (PONV). The aim of this study was to investigate the effects of ramosetron and dexamethasone on PONV, pain, and shivering and to determine the correlations between nausea, pain, and shivering. For this study, 123 patients scheduled for thyroid surgery were randomly allocated to one of three groups: the control group (group C, n = 41), dexamethasone group (group D, n = 41), or the ramosetron group (group R, n = 41). The patients were treated intravenously with 2 mL of 0.9 % NaCl, 2 mL of 5 mg/mL dexamethasone, or 2 mL of 0.15 mg/mL ramosetron immediately after anesthesia. The overall incidence and severity of postoperative nausea and the level of antiemetic consumption were significantly lower in group R compared with group D, and these parameters were significantly lower in groups R and D than in group C. There were significant differences in the incidence and severity of shivering, severity of pain, and analgesic consumption between group C and group R or D, but the incidence of shivering, pain severity, and analgesic consumption did not differ between groups R and D. The severity of shivering was significantly lower in group R than in group D. The correlation coefficients for shivering and pain, shivering and nausea, and pain and nausea were 0.210 (P = 0.010), 0.106 (P = 0.198), and 0.190 (P = 0.035), respectively, in group C. Two antiemetic drugs, ramosetron and dexamethasone, significantly reduced the incidence and severity of postoperative nausea and the need for administration of rescue antiemetic drugs. Furthermore, both drugs effectively decreased the severity of pain and shivering. Ramosetron was superior to dexamethasone for reducing nausea, antiemetic consumption, and the severity of nausea, but not for reducing the incidence of shivering. Further studies are required to elucidate the correlations between postoperative nausea, pain, and shivering, as a statistically significant but weak correlation was shown in the present study.