Date of Award

2012

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not intravenous ramosetron 0.3 mg is effective in the prevention of postoperative nausea and vomiting (PONV) in women undergoing gynecologic surgery.

STUDY DESIGN: Review of three English language primary research articles published later than 1995.

DATA SOURCES: Randomized, double-blinded, controlled clinical trials comparing intravenous ramosetron to placebo or other control groups were identified using Ovid MEDLINE and Cochrane Library databases.

OUTCOMES MEASURED: Measured outcomes include a complete response to the intervention within the first 24-48 hours, the incidence of postoperative nausea and vomiting, need for rescue antiemetic, severity of nausea, and patient satisfaction.

RESULTS: All three RCTs analyzed found that intravenous ramosetron 0.3 mg administered during or immediately after surgery significantly decreased the incidence, compared to placebo, of patients experiencing any PONV. This effect was found to be particularly strong in the earliest postoperative period in all studies. In all three studies, ramosetron also significantly reduced the severity of nausea and increased patient satisfaction compared to placebo. Two out of the three studies showed that ramosetron reduced the need for rescue treatment of PONV in the postoperative period compared to placebo. Adverse effects were limited to drowsiness, dizziness, and headache and there were no significant difference in incidence between any groups in any of the studies.

CONCLUSION: PONV is a significant source of distress for women undergoing gynecologic surgery. The studies analyzed in this review are concordant in their finding that ramosetron, a highly selective 5-HT3 antagonist, is a safe and effective option for completely preventing or reducing the severity of this troubling postoperative complication. The effectiveness of ramosetron in these studies is complemented by its availability as a less-expensive oral disintegrating tablet which may offset criticism of the high cost of currently available 5-HT3 antagonists. Future studies are needed to apply these findings to additional surgical populations.

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