Dose-Ranging Study of Ramosetron for the Prevention of Nausea and Vomiting after Laparoscopic Gynecological Surgery: A Prospective Randomized Study

Abstract

Patients undergoing laparoscopic gynecologic surgery and receiving postoperative analgesia with opioids have a high risk of postoperative nausea and vomiting (PONV). We compared the antiemetic efficacy of three doses of ramosetron in this high-risk population. In this prospective, double-blind trial, 174 patients randomly received ramosetron 0.3 mg (R0.3 group; n = 58), 0.45 mg (R0.45 group; n = 58), or 0.6 mg (R0.6 group; n = 58) at the end of surgery. The primary outcome was the incidence of PONV during the first postoperative 48 h. Nausea severity, pain scores, adverse events, and patient satisfaction (1–4; 4, excellent) were assessed. The incidence of PONV was not different between groups (35%, 38%, and 35% in R0.3, R0.45, and R0.6 groups; p = 0.905). Nausea severity, pain scores, and incidence of adverse events (dizziness, headache, or sedation) were similar between groups. Compared to the R0.3 group, the R0.45 and R0.6 groups had lower incidence of premature discontinuation of fentanyl-based patient-controlled analgesia primarily because of intractable PONV (9% and 5% vs. 24%; p = 0.038), and higher satisfaction scores (3.4 ± 0.8 and 3.3 ± 0.7 vs. 2.4 ± 0.9; p = 0.005). Compared to ramosetron 0.3 mg, ramosetron 0.45 and 0.6 mg did not reduce PONV, but reduced premature discontinuation of patient-controlled analgesia and increased patient satisfaction, without increasing adverse events.

Effect of dexamethasone and ramosetron on the prevention of postoperative nausea and vomiting in low-risk patients: a randomized, double-blind, placebo-controlled, multicenter trial

“…Participants and outcome assessors were blinded to group allocation. Patients in group C received intravenous saline (2 mL) at the end of the surgery, those in group R received intravenous ramosetron (0.3 mg; 2 mL) (Nasea®, Daiichisankyo.co.kr, Seoul, Republic of Korea) at the end of the surgery, and those in group DR received a combination of intravenous dexamethasone (5 mg; 1 mL) before the induction of anesthesia and intravenous ramosetron (0.3 mg; 2 mL) at the end of the surgery [ 9 , 11 ].…”

Comparing the effects of continuous infusion of esmolol and ramosetron alone and in combination on nausea and vomiting after laparoscopic cholecystectomy: A prospective, randomized, double-blind study

“…[ 6 ] Ramosetron, a popular 5-HT3 receptor antagonist, has a stronger receptor affinity and a longer duration of action than other 5-HT3 receptors because of its slow degradation. [ 7 ]…”

“…[6] Ramosetron, a popular 5-HT3 receptor antagonist, has a stronger receptor affinity and a longer duration of action than other 5-HT3 receptors because of its slow degradation. [7] Esmolol is an ultra-short-acting beta-adrenergic receptor antagonist that selectively affects the cardiovascular system. It reduces sympathetic activity induced by surgical or harmful stimuli, thereby preventing substantial hemodynamic changes.…”

“…[8,9] Generally, ramosetron is used for the prevention of PONV, while esmolol can help in preventing PONV by providing patient hemodynamic stability during surgeries. [7,8,10,11] In previous studies, various antiemetics have been used in combination to reduce PONV. [12] However, there have been no reports on the effect of the combined use of ramosetron and esmolol on PONV.…”

Effects of modified multimodal analgesia on postoperative pain, sedation, and prognosis of gynecological patients

“…Laparoscopic operation is favored by modern medicine because of its advantages of less trauma and rapid recovery. However, the incidence of postoperative complications including postoperative nausea and vomiting (PONV) can be as high as 80%, which may markedly affect the postoperative rehabilitation of patients 1 . Female patients are more sensitive to pain; nerve block is rarely used in traditional gynecological anesthesia for technical reasons or equipment shortage.…”