Efficacy And Safety Of Intravenous Palonosetron In Prevention Of Postoperative Nausea And Vomiting In Adults: A Systematic Review And Meta-analysis

Objectivessystematically review the effect and safety of palonosetron on postoperative nausea andvomiting (PONV) in randomized controlled trials in patients who received generalanesthesia.MethodsWe performed a literature search of English and Chinese references using all theMEDLINE、EMBASE、CNKI databases from January2003to December2013，as wellas manual search for the reference of the selected RCT. Double-blinded, randomized,controlled trials comparing the efficiency of the prophylactic administration ofpalonosetron and/or other first-generation5-HT3RA therapy during general anesthesiawere included. The methodological quality of the included studies was assessed and thedata was extracted according to the Cochrane Reviewer’s Handbook. Meta-analyses wereperformed using RevMan5.1software.Results1.Meta-analyses showed statistically significant differences in favor of palonosetroncompared with placebo in prevention of postoperative nausea and/or vomiting (p<0.01)during0-6h、0-24h and24-72h;2.The incidence of postoperative nausea was significantly lower in the palonosetrongroup compared with the ondansetron group during0-24h and>24h after surgery. Therewere significant statistical differences in postoperative vomiting between both groupsduring0-24h with out different during>24h. The incidence of overall side-effects, such asheadache, dizziness, or drowsiness, was different between groups. Subgroup analyses showed statistically significant differences with lower incidence of headache inpalonosetron group.3. Compared with ramosetron, palonsetron group do not show a statistically significantdifference in preventing postoperative nausea in any time windows (p>0.05) except for48-2h(p<0.05), and there is not different between two groups for postoperative vomitingand side-effects.(p>0.05)；4. Combination therapy of palonosetron and dexamethasone did not reduce the incidenceof PONV when compared with palonosetron alone in any time windows of0-72h.Conclusions1.Palonosetron0.075mg is more effective than placebo on preventing from PONV.2. the incidence of PONV between the ondansetron organ and the palonosetron group didnot shown the difference in postoperative nausea and vomiting during>24h time windowafter surgery, although palonosetron resulted in a lower incidence of nausea and vomiting0-24h and>24h after surgery.3.The incidence of overall nausea and vomiting did not differ in0-6h,6-24h and24-48hafter surgery, but was significantly lower in palonosetron group compared withramosetron group during in48-72h time window.4. The combination therapy of palonosetron and dexamethasone did not reduce theincidence of PONV or PDNV when compared with palonosetron alone.