Comparison of efficacy and safety between palonosetron and ondansetron to prevent postoperative nausea and vomiting in patients undergoing non-laparoscopic surgery: A systematic review and meta-analysis of randomised controlled trials
Background and Aims: Postoperative nausea and vomiting (PONV) is a common and distressing complication in all types of surgeries involving general anaesthesia. To establish evidence for best clinical practices, this meta-analysis compares the efficacy and safety of palonosetron and ondansetron in pr...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-01-01
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| Series: | Indian Journal of Anaesthesia |
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| Online Access: | https://journals.lww.com/10.4103/ija.ija_1017_24 |
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| author | Babu Lal Ragavi Alagarsamy Jitendra Kumar Anshul J. Rai Vineeta Yadav Rajnish Joshi Md. Yunus |
| author_facet | Babu Lal Ragavi Alagarsamy Jitendra Kumar Anshul J. Rai Vineeta Yadav Rajnish Joshi Md. Yunus |
| author_sort | Babu Lal |
| collection | DOAJ |
| description | Background and Aims:
Postoperative nausea and vomiting (PONV) is a common and distressing complication in all types of surgeries involving general anaesthesia. To establish evidence for best clinical practices, this meta-analysis compares the efficacy and safety of palonosetron and ondansetron in preventing PONV in patients undergoing non-laparoscopic surgeries.
Methods:
A PRISMA-guided systematic review and meta-analysis was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library to identify comparative studies that reported the efficacy (nausea and vomiting) at postoperative time points, namely T1 (0–2 hours), T2 (0–6 hours), T3 (12–24 hours), T4 (24–48 hours), and T5 (24–72 hours), as well as safety (number of incidence of adverse effects). A meta-analysis of the efficacy and safety groups was performed using a random-effects model.
Results:
Nineteen randomised controlled trials were included. Pooled risk ratio (RR) revealed that patients receiving palonosetron were significantly less likely to develop nausea [0–2 h, RR = 0.82 (95% confidence interval (CI): 0.50, 1.34), P = 0.317, I2 = 15.3%], [0–6 h, RR = 0.76 (95% CI: 0.44, 1.29), P = 0.137, I2 = 45.7%], [12–24 h, RR = 0.39 (95%CI: 0.16, 0.96), P = 0.088, I2 = 54.2%], [24–48 h, RR = 0.44 (95% CI: 0.20, 0.96), P = 0.598, I2 = 0%], [24–72 h, RR 0.22 (95% CI: 0.08, 0.57), P = 0.119, I2 = 53.0%] and vomiting [0–2 h, RR = 0.59 (95% CI: 0.29, 1.23), P = 0.868, I2 = 0%], [0–6 h, RR = 1.42 (95% CI: 0.74, 2.72), P = 0.790, I2 = 0%], [12–24 h, RR = 0.14 (95% CI: 0.04, 0.51), P = 0.749, I2 = 0.0%], [24–48 h, RR = 0.24 (95%CI: 0.09, 0.62), P = 0.561, I2 = 0%], [24–72 h, RR = 0.11 (95% CI: 0.02, 0.58), P = 0.859, I2 = 0%]. The safety profiles of palonosetron and ondansetron were comparable [headache: RR = 0.82 (95%CI: 0.65, 1.04), P = 0.940, I2 = 0%], [drowsiness: RR = 0.96 (95%CI: 0.54, 1.71), P = 0.870, I2 = 0%], [constipation: RR=1.20 (95%CI: 0.52, 2.79), P = 0.650, I2 = 0%], [dizziness: RR = 0.60 (95%CI: 0.44, 0.83), P = 0.644, I2 = 0%].
Conclusion:
Palonosetron and ondansetron exhibited comparable efficacy in the early hours (0–6 h). Palonosetron showed superior efficacy beyond 6 hours, providing sustained PONV prophylaxis in patients undergoing various surgeries, excluding laparoscopic procedures. |
| format | Article |
| id | doaj-art-ec1c9e864fc1410a8e10fdac350da0e3 |
| institution | Kabale University |
| issn | 0019-5049 0976-2817 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Anaesthesia |
| spelling | doaj-art-ec1c9e864fc1410a8e10fdac350da0e32025-02-06T05:26:09ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172025-01-0169110812210.4103/ija.ija_1017_24Comparison of efficacy and safety between palonosetron and ondansetron to prevent postoperative nausea and vomiting in patients undergoing non-laparoscopic surgery: A systematic review and meta-analysis of randomised controlled trialsBabu LalRagavi AlagarsamyJitendra KumarAnshul J. RaiVineeta YadavRajnish JoshiMd. YunusBackground and Aims: Postoperative nausea and vomiting (PONV) is a common and distressing complication in all types of surgeries involving general anaesthesia. To establish evidence for best clinical practices, this meta-analysis compares the efficacy and safety of palonosetron and ondansetron in preventing PONV in patients undergoing non-laparoscopic surgeries. Methods: A PRISMA-guided systematic review and meta-analysis was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library to identify comparative studies that reported the efficacy (nausea and vomiting) at postoperative time points, namely T1 (0–2 hours), T2 (0–6 hours), T3 (12–24 hours), T4 (24–48 hours), and T5 (24–72 hours), as well as safety (number of incidence of adverse effects). A meta-analysis of the efficacy and safety groups was performed using a random-effects model. Results: Nineteen randomised controlled trials were included. Pooled risk ratio (RR) revealed that patients receiving palonosetron were significantly less likely to develop nausea [0–2 h, RR = 0.82 (95% confidence interval (CI): 0.50, 1.34), P = 0.317, I2 = 15.3%], [0–6 h, RR = 0.76 (95% CI: 0.44, 1.29), P = 0.137, I2 = 45.7%], [12–24 h, RR = 0.39 (95%CI: 0.16, 0.96), P = 0.088, I2 = 54.2%], [24–48 h, RR = 0.44 (95% CI: 0.20, 0.96), P = 0.598, I2 = 0%], [24–72 h, RR 0.22 (95% CI: 0.08, 0.57), P = 0.119, I2 = 53.0%] and vomiting [0–2 h, RR = 0.59 (95% CI: 0.29, 1.23), P = 0.868, I2 = 0%], [0–6 h, RR = 1.42 (95% CI: 0.74, 2.72), P = 0.790, I2 = 0%], [12–24 h, RR = 0.14 (95% CI: 0.04, 0.51), P = 0.749, I2 = 0.0%], [24–48 h, RR = 0.24 (95%CI: 0.09, 0.62), P = 0.561, I2 = 0%], [24–72 h, RR = 0.11 (95% CI: 0.02, 0.58), P = 0.859, I2 = 0%]. The safety profiles of palonosetron and ondansetron were comparable [headache: RR = 0.82 (95%CI: 0.65, 1.04), P = 0.940, I2 = 0%], [drowsiness: RR = 0.96 (95%CI: 0.54, 1.71), P = 0.870, I2 = 0%], [constipation: RR=1.20 (95%CI: 0.52, 2.79), P = 0.650, I2 = 0%], [dizziness: RR = 0.60 (95%CI: 0.44, 0.83), P = 0.644, I2 = 0%]. Conclusion: Palonosetron and ondansetron exhibited comparable efficacy in the early hours (0–6 h). Palonosetron showed superior efficacy beyond 6 hours, providing sustained PONV prophylaxis in patients undergoing various surgeries, excluding laparoscopic procedures.https://journals.lww.com/10.4103/ija.ija_1017_24antiemetic drugsmeta-analysisnauseaondansetronpalonosetronpostoperative nausea and vomitingsystematic reviewvomiting |
| spellingShingle | Babu Lal Ragavi Alagarsamy Jitendra Kumar Anshul J. Rai Vineeta Yadav Rajnish Joshi Md. Yunus Comparison of efficacy and safety between palonosetron and ondansetron to prevent postoperative nausea and vomiting in patients undergoing non-laparoscopic surgery: A systematic review and meta-analysis of randomised controlled trials Indian Journal of Anaesthesia antiemetic drugs meta-analysis nausea ondansetron palonosetron postoperative nausea and vomiting systematic review vomiting |
| title | Comparison of efficacy and safety between palonosetron and ondansetron to prevent postoperative nausea and vomiting in patients undergoing non-laparoscopic surgery: A systematic review and meta-analysis of randomised controlled trials |
| title_full | Comparison of efficacy and safety between palonosetron and ondansetron to prevent postoperative nausea and vomiting in patients undergoing non-laparoscopic surgery: A systematic review and meta-analysis of randomised controlled trials |
| title_fullStr | Comparison of efficacy and safety between palonosetron and ondansetron to prevent postoperative nausea and vomiting in patients undergoing non-laparoscopic surgery: A systematic review and meta-analysis of randomised controlled trials |
| title_full_unstemmed | Comparison of efficacy and safety between palonosetron and ondansetron to prevent postoperative nausea and vomiting in patients undergoing non-laparoscopic surgery: A systematic review and meta-analysis of randomised controlled trials |
| title_short | Comparison of efficacy and safety between palonosetron and ondansetron to prevent postoperative nausea and vomiting in patients undergoing non-laparoscopic surgery: A systematic review and meta-analysis of randomised controlled trials |
| title_sort | comparison of efficacy and safety between palonosetron and ondansetron to prevent postoperative nausea and vomiting in patients undergoing non laparoscopic surgery a systematic review and meta analysis of randomised controlled trials |
| topic | antiemetic drugs meta-analysis nausea ondansetron palonosetron postoperative nausea and vomiting systematic review vomiting |
| url | https://journals.lww.com/10.4103/ija.ija_1017_24 |
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