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Ramosetron versus ondansetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

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Abstract

Background

Patients undergoing general anesthesia for laparoscopic cholecystectomy are at high risk for postoperative nausea and vomiting (PONV). This study compared ramosetron and ondansetron in terms of efficacy for PONV prevention after laparoscopic cholecystectomy.

Methods

For this study, 120 patients scheduled to undergo laparoscopic cholecystectomy were randomized (in double-blind fashion) to receive 4 mg of ondansetron (group O4, n = 40), 8 mg of ondansetron (group O8, n = 40), or 0.3 mg of ramosetron (group R, n = 40) intravenously after surgery. Postoperative nausea, retching, vomiting, pain, and side effects were assessed at 2 h, 24 h, and 48 h after surgery.

Results

No statistical differences were observed among the three groups with regard to patient characteristics and information on surgery and anesthesia. The ratio of complete response (no PONV for 2 h) was higher for groups O8 and R than for group O4 as follows: 80% (n = 32) for groups O8 and R versus 58% (n = 23) for group O4 during the first postoperative 2 h (p = 0.04), 90% (n = 36) for groups O8 and R versus 76% (n = 30) for group O4 over 24 h (2–24 h) (p = 0.09), and 98% (n = 38) for groups O4 and O8 versus 100% (n = 40) for group R over the next 24 h (24–48 h) after surgery (p = 0.36). During the first 2 h after surgery, rescue antiemetics were used for significantly fewer patients in groups O8 and R (20%) than in group O4 (42.5%) (p = 0.04). Postoperative pain and the use of rescue analgesics were comparable among the groups. There was no clinically serious adverse event due to the study drugs.

Conclusion

Ramosetron 0.3 mg and ondansetron 8 mg are more effective than ondansetron 4 mg for the prevention of PONV (2 h). Ramosetron 0.3 mg is as effective as ondansetron 8 mg for the prophylaxis of PONV after laparoscopic cholecystectomy.

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References

  1. Watcha MF, White PF (1992) Postoperative nausea and vomiting: its etiology, treatment, and prevention. Anesthesiology 77:161–184

    Article  Google Scholar 

  2. Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S, Kovac A, Philip BK, Sessler DI, Temo J, Tramèr MR, Watcha M (2003) Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg 97:62–71

    Article  PubMed  Google Scholar 

  3. Stadler M, Bardiau F, Seidel L, Albert A, Boogaerts JG (2003) Difference in risk factors for postoperative nausea and vomiting. Anesthesiology 98:46–52

    Article  PubMed  Google Scholar 

  4. Tramer MR (2004) Strategies for postoperative nausea and vomiting. Best Pract Res Clin Anaesthesiol 18:693–701

    Article  PubMed  Google Scholar 

  5. Fujii Y (2005) The utility of antiemetics in the prevention and treatment of postoperative nausea and vomiting in patients scheduled for laparoscopic cholecystectomy. Curr Pharmaceut Des 11:3173–3183

    Article  CAS  Google Scholar 

  6. Nesek-Adam V, Grizelj-Stojcic E, Rasic Z, Cala Z, Mrsic V, Smiljanic A (2007) Comparison of dexamethasone, metoclopramide, and their combination in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Surg Endosc 21:607–612

    Article  CAS  PubMed  Google Scholar 

  7. Santon JM (1991) Anaesthesia for laparoscopic cholecystectomy. Anaesthesia 46:317

    Article  Google Scholar 

  8. Thune A, Appelgren L, Haglind E (1995) Prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospective randomized study of metoclopramide and transdermal hyoscine. Eur J Surg 161:265–268

    CAS  PubMed  Google Scholar 

  9. Sohi HS, Heipel J, Inman KJ, Chinnick B, Cunningham DG, Holliday RL, Girotti MJ (1994) Preoperative transdermal scopolamine does not reduce the level of nausea and frequency of vomiting after laparoscopic cholecystectomy. Can J Surg 37:307–312

    CAS  PubMed  Google Scholar 

  10. Kothari SN, Boyd WC, Bottcher ML, Lambert PJ (2000) Antiemetic efficacy of prophylactic dimenhydrinate (Dramamine) vs ondansetron (Zofran): a randomized, prospective trial of inpatients undergoing laparoscopic cholecystectomy. Surg Endosc 14:926–929

    Article  CAS  PubMed  Google Scholar 

  11. Parlow JL, Meikle AT, van Vlymen J, Avery N (1999) Postdischarge nausea and vomiting after ambulatory laparoscopy is not reduced by promethazine prophylaxis. Can J Anaesth 46:719–724

    Article  CAS  PubMed  Google Scholar 

  12. Fujii Y, Tanaka H, Toyooka H (1999) Prophylactic antiemetic therapy with droperidol in patients undergoing laparoscopic cholecystectomy. J Anesth 13:140–143

    Article  CAS  PubMed  Google Scholar 

  13. Leksowski K, Peryga P, Szyca R (2006) Ondansetron, metoclopramid, dexamethasone, and their combinations compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a prospective randomized study. Surg Endosc 20:878–882

    Article  CAS  PubMed  Google Scholar 

  14. Morgan GE, Mikhail MS, Murray MJ (2002) Adjuncts to anesthesia. In: Morgan GE, Mikhail MS, Murray MJ (eds) Clinical anesthesiology. McGraw-Hill, New York, pp 242–252

    Google Scholar 

  15. Hesketh PJ, Gandara DR (1991) Serotonin antagonists: a new class of antiemetic agents. J Natl Cancer Inst 83:613–620

    Article  CAS  PubMed  Google Scholar 

  16. Tramer MR, Moore RA, Reynolds DJ, McQuay HJ (1997) A quantitative systematic review of ondansetron in the treatment established postoperative nausea and vomiting. Anesthesiology 314:1088–1089

    CAS  Google Scholar 

  17. Helmy SA (1999) Prophylactic antiemetic efficacy of ondansetron in laparoscopic cholecystectomy under total intravenous anaesthesia: a randomised, double-blind comparison with droperidol, metoclopramide and placebo. Anaesthesia 54:266–270

    Article  CAS  PubMed  Google Scholar 

  18. Naguib M, el Bakry AK, Khoshim MH, Channa AB, el Gammal M, el Gammal K, Elhattab YS, Attia M, Saddique A (1996) Prophylactic antiemetic therapy with ondansetron, tropisetron, granisetron, and metoclopramide in patients undergoing laparoscopic cholecystectomy: a randomized, double-blind comparison with placebo. Can J Anaesth 43:226–231

    Article  CAS  PubMed  Google Scholar 

  19. Shi Y, He X, Yang S, Ai B, Zhang C, Huang D, Dong M, Liu P, Zhou S, Han X (2007) Ramosetron versus ondansetron in the prevention of chemotherapy-induced gastrointestinal side effects: a prospective randomized controlled study. Chemotherapy 53:44–50

    Article  CAS  PubMed  Google Scholar 

  20. Kang YK, Park YH, Ryoo BY, Bang YJ, Cho KS, Shin DB, Kim HC, Lee KH, Park YS, Lee KS, Heo DS, Kim SY, Cho EK, Lim HY, Kim WK, Lee JA, Kim TY, Lee JC, Yoon HJ, Kim NK (2002) Ramosetron for the prevention of cisplatin-induced acute emesis: a prospective randomized comparison with granisetron. J Int Med Res 30:220–229

    CAS  PubMed  Google Scholar 

  21. Fujii Y, Tanaka H (2002) Comparison of granisetron and ramosetron for the prevention of nausea and vomiting after thyroidectomy. Clin Ther 24:766–772

    Article  CAS  PubMed  Google Scholar 

  22. Fujii Y, Tanaka H (2002) Double-blind, placebo-controlled, dose-ranging study of ramosetron for the prevention of nausea and vomiting after thyroidectomy. Clin Ther 24:1148–1153

    Article  CAS  PubMed  Google Scholar 

  23. Fujii Y, Uemura A, Tanaka H (2002) Prophylaxis of nausea and vomiting after laparoscopic cholecystectomy with ramosetron: randomised controlled trial. Eur J Surg 168:583–586

    Article  CAS  PubMed  Google Scholar 

  24. Quaynor H, Raeder JC (2002) Incidence and severity of postoperative nausea and vomiting are similar after metoclopramide 20 mg and ondansetron 8 mg given by the end of laparoscopic cholecystectomies. Acta Anaesthesiol Scand 46:109–113

    Article  CAS  PubMed  Google Scholar 

  25. Grond S, Lynch J, Diefenbach C, Altrock K, Lehmann KA (1995) Comparison of ondansetron and droperidol in the prevention of nausea and vomiting after inpatient minor gynecologic surgery. Anesth Analg 81:603–607

    Article  CAS  PubMed  Google Scholar 

  26. Honkavaara P (1996) Effect of ondansetron on nausea and vomiting after middle ear surgery during general anaesthesia. Br J Anaesth 76:316–318

    CAS  PubMed  Google Scholar 

  27. Paventi S, Santevecchi A, Ranieri R (2001) Efficacy of a single-dose ondansetron for preventing postoperative nausea and vomiting after laparoscopic cholecystectomy with sevoflurane and remifentanil infusion anaesthesia. Eur Rev Med Pharmacol Sci 5:59–63

    CAS  PubMed  Google Scholar 

  28. Fujii Y, Tanaka H, Somekawa Y (2004) A randomized, double-blind, placebo-controlled trial of ramosetron for preventing nausea and vomiting during termination of pregnancy. Int J Obstet Anesth 13:15–18

    Article  CAS  PubMed  Google Scholar 

  29. Fujii Y, Saitoh Y, Tanaka H, Toyooka H (2000) Ramosetron for preventing postoperative nausea and vomiting in women undergoing gynecological surgery. Anesth Analg 90:472–475

    Article  CAS  PubMed  Google Scholar 

  30. Gepstein R, Arinzon Z, Folman Y, Shuval I, Shabat S (2007) Efficacy and complications of patient-controlled analgesia treatment after spinal surgery. Surg Neurol 67:360–366

    Article  PubMed  Google Scholar 

  31. Papadimitriou L, Livanios S, Katsaros G, Hassiakos D, Koussi T, Demesticha T (2001) Prevention of postoperative nausea and vomiting after laparoscopic gynaecological surgery: combined antiemetic treatment with tropisetron and metoclopramide vs metoclopramide alone. Eur J Anaesthesiol 18:615–619

    CAS  PubMed  Google Scholar 

  32. Sanchez-Ledesma MJ, Lopez-Olaondo L, Pueyo FJ, Carrascosa F, Ortega A (2002) A comparison of three antiemetic combinations for the prevention of postoperative nausea and vomiting. Anesth Analg 95:1590–1595

    Article  CAS  PubMed  Google Scholar 

  33. Biswas BN, Rudra A (2003) Comparison of granisetron and granisetron plus dexamethasone for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 47:79–83

    Article  CAS  PubMed  Google Scholar 

  34. Coloma M, White PF, Markowitz SD, Whitten CW, Macaluso AR, Berrisford SB, Thornton KC (2002) Dexamethasone in combination with dolasetron for prophylaxis in the ambulatory setting: effect on outcome after laparoscopic cholecystectomy. Anesthesiology 96:1346–5130

    Article  CAS  PubMed  Google Scholar 

  35. Caldwell CB, Ricotta JJ (1987) Changes in visceral blood flow with elevated intraabdominal pressure. J Surg Res 43:14–20

    Article  CAS  PubMed  Google Scholar 

  36. Diebel LN, Dulchavsky SA, Wilson RF (1992) Effect of increased intraabdominal pressure on mesenteric arterial and intestinal mucosal blood flow. J Trauma 33:45–48

    Article  CAS  PubMed  Google Scholar 

  37. Goll V, Akça O, Greif R, Freitag H, Arkiliç CF, Scheck T, Zoeggeler A, Kurz A, Krieger G, Lenhardt R, Sessler DI (2001) Ondansetron is no more effective than supplemental intraoperative oxygen for prevention of postoperative nausea and vomiting. Anesth Analg 92:112–117

    Article  CAS  PubMed  Google Scholar 

  38. Fujii Y, Saitoh Y, Tanaka H, Toyooka H (1999) Ramosetron vs granisetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Can J Anaesth 46:991–993

    Article  CAS  PubMed  Google Scholar 

  39. Choi YS, Shim JK, Yoon do H, Jeon DH, Lee JY, Kwak YL (2008) Effect of ramosetron on patient-controlled analgesia-related nausea and vomiting after spine surgery in highly susceptible patients: comparison with ondansetron. Spine 33:E602–E606

    Article  PubMed  Google Scholar 

  40. Hartung J (1996) Twenty-four of twenty-seven studies show a greater incidence of emesis with nitrous oxide than with alternative anesthetics. Anesth Analg 83:114–116

    Article  CAS  PubMed  Google Scholar 

  41. Tramer M, Moore A, McQuay H (1996) Omitting nitrous oxide in general anesthesia: meta-analysis of intraoperative, awareness, and postoperative emesis in randomized controlled trials. Br J Anaesth 76:186–193

    CAS  PubMed  Google Scholar 

  42. Rosow CE (1999) An overview of remifentanil. Anesth Analg 89:S1–S3

    Article  CAS  PubMed  Google Scholar 

  43. Glass PS, Gan TJ, Howell S (1999) A review of the pharmacokinetics and pharmacodynamics of remifentanil. Anesth Analg 89:S7–S14

    Article  CAS  PubMed  Google Scholar 

  44. Kapila A, Glass PS, Jacobs JR, Muir KT, Hermann DJ, Shiraishi M, Howell S, Smith RL (1995) Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology 83:968–975

    Article  CAS  PubMed  Google Scholar 

  45. Song D, White PF (1999) Remifentanil as an adjuvant during desflurane anesthesia facilitates early recovery after ambulatory surgery. J Clin Anesth 11:364–367

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166 Kumi-ro, Bundang-gu, Seongnam-si, Kyonggi-do, 463-707, South Korea

    Junghee Ryu, Yun-Mi So, Jungwon Hwang & Sang-Hwan Do

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  1. Junghee Ryu
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Correspondence to Sang-Hwan Do.

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Ryu, J., So, YM., Hwang, J. et al. Ramosetron versus ondansetron for the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy. Surg Endosc 24, 812–817 (2010). https://doi.org/10.1007/s00464-009-0670-5

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  • DOI: https://doi.org/10.1007/s00464-009-0670-5

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