Search

Background: Postoperative nausea and vomiting (PONV) is one of the most unpleasant complications of anaesthesia and is more common following middle ear surgeries. Ondansetron, a 5-HT3 (5-hydroxytryptamine type 3) receptor antagonist provides significant reduction in early PONV. The other 5-HT3 antagonist ramosetron, with long duration of action, has been found to be more effective than ondansetron in reducing the early as well as delayed PONV. The antiemetic effects of glucocorticoids (dexamethasone and methylprednisolone) are well documented. So, the present study was designed to compare the efficacy of the combination of intravenous methylprednisolone and ondansetron with combination of intravenous methylprednisolone and ramosterone in preventing postoperative nausea and vomiting in patients undergoing middle ear surgeries. Methods: Sixty patients in the age group of 18-60 years, with American Society of Anaesthesiologists (ASA) physical status classification I or II, undergoing middle ear surgery were randomly allocated to receive a combination of methylprednisolone 40 mg (given at the beginning of surgery) and ondansetron 4 mg (given near the end of surgery) (group MO, n=30) or combination of intravenous methylprednisolone 40 mg and ramosetron 0.3 mg (near the end of surgery) (group R, n=30), by a computer-generated randomization table. Incidence of PONV in the both groups were studied and compared. Results: There was no significant difference in PONV between the groups in the first 2 h after the surgery. Between 2 and 24 h, the incidence of nausea was significantly lower in the methylprednisolone and ondansetron group compared to the methylprednisolone and ramosetron group (P=0.01). Between 24 and 48 h, there was no difference between the two groups with respect to incidence of nausea and vomiting. Conclusion: The combination of methylprednisolone and ondansetron is superior to combination of methylprednisolone and ramosetron for prevention of PONV after middle ear surgery especially in treatment of early PONV. Therefore, we recommend combination of methylprednisolone and ondansetron for prophylaxis for PONV in middle ear surgeries.

BACKGROUND The incidence of pain on propofol injection varies between 28 – 90 % during induction and may be severe. Ramosetron has been proved efficacious in reducing propofol pain in adults but not in children, therefore we conducted this double blinded randomized controlled study to determine the effectiveness of ramosetron in attenuating propofol induced pain in children. The purpose of this study was to compare the effectiveness of injection ramosetron, a 5HT3 antagonist and lidocaine, the commonest drug for attenuation of pain caused by injection propofol. METHODS This is a randomised double-blinded study. Eighty children of American Society of Anaesthesiologist (ASA) grade I - II, aged 4 - 14 years, undergoing elective surgical procedures under general anaesthesia were randomly assigned to two groups of 40 each. Group PR received 6 µg/kg of ramosetron and Group PL received 0.2 mg/kg of 2 % lidocaine. After injection of study drug, occlusion of venous drainage was done manually by a trained assistant at mid-arm for 60 seconds. After releasing manual occlusion Injection propofol (1 %) 2 mg/kg was administered slowly over a period of 5 seconds. A four point scale was used to assess the severity of pain. The results were analysed by using unpaired student’s t - test and chi-square test/Fisher’s exact test. P value of < 0.05 was considered statistically significant. RESULTS The demographic characteristics were comparable in both groups. The incidence of no pain in Group PR and Group PL was 60 % (N = 24) and 65 % (N = 26) respectively which was comparable. The incidence of mild, moderate and severe pain was comparable in both groups. The overall incidence of propofol injection pain in group PL and group PR was 35 % and 40 % respectively (P = 0.862). CONCLUSIONS Intravenous ramosetron at a dose of 6 µg/kg can effectively attenuate the propofol induced pain comparable to 0.2 mg/kg of lidocaine in children. KEYWORDS Children, Lidocaine, Propofol Induced Pain, Ramosetron

Nausea, vomiting, and renal injury are the common adverse effects associated with cisplatin. Cisplatin is excreted via the multidrug and toxin release (MATE) transporter, and the involvement of the MATE transporter in cisplatin-induced kidney injury has been reported. The MATE transporter is also involved in the excretion of ondansetron, but the effects of 5-HT3 receptor antagonists used clinically for cisplatin-induced renal injury have not been elucidated. Therefore, the aim of this study was to investigate the effects of 5-HT3 receptor antagonists in a mouse model of cisplatin-induced kidney injury and to validate the results using medical big data analysis of more than 1.4 million reports and a survey of 3000 hospital medical records. The concomitant use of a first-generation 5-HT3 receptor antagonist (ondansetron, granisetron, or ramosetron) significantly increased cisplatin accumulation in the kidneys and worsened renal damage. Conversely, the concomitant use of palonosetron had no effect on renal function compared with the use of cisplatin alone. Furthermore, an analysis of data from the US Food and Drug Administration Adverse Event Reporting System and retrospective medical records revealed that the combination treatment of cisplatin and a first-generation 5-HT3 receptor antagonist significantly increased the number of reported renal adverse events compared with the combination treatment of cisplatin and a second-generation 5-HT3 receptor antagonist. These results suggest that compared with the first-generation antagonists, second-generation 5-HT3 receptor antagonists do not worsen cisplatin-induced acute kidney injury. The findings should be validated in a prospective controlled trial before implementation in clinical practice.

Introduction and Aims: Postoperative nausea and vomiting (PONV) are very common and distressing adverse events after general anaesthesia. Palonosetron and ramosetron are newer, second generation, selective 5-HT3 receptor antagonists. The present study was carried out to compare the efficacy and safety of palonosetron and ramosetron for prevention of postoperative nausea and vomiting (PONV) over the period of 72 hours in patients undergoing for laparoscopic surgery under general anaesthesia. Materials and Methods: 80 patients of ASA class I and II undergoing for various laparoscopic surgeries were randomly allocated into 2 groups of 40 each, to receive Inj. palonosetron 75 ?g (group P) or Inj. Ramosetron 0.3 mg (group R). Patients were monitored for emesis, severity of nausea, requirement of rescue antiemetic and complete response up to 72 hours (0-6, 6-24, 24-72) post operatively. Results: During 0-6 hours, severity of PONV was comparable in both drug groups but during 24-72 hours, PONV score 2 was observed in 5% and 17.5% of patients of group P and group R respectively (p=0.027). While score 3 was observed in 15% of patients of group R and none of the patients of group P (p=0.01). On comparison of complete response between Group P and Group R, at 0-6 hours response was almost equal but during 6-24 hours and 24-72 hours number of patient having complete response were more in Group P (97.5% and 82.5%) as compared to Group R (65% and 57% respectively). Conclusion: Palonosetron given as a prophylaxis for post-operative nausea and vomiting (PONV) in patients undergoing for laparoscopic surgeries seems to have better antiemetic effect over ramosetron. Keywords: PONV, Palonosetron, Ramosetron, Laparoscopic surgery.

Background and objectives Patient-controlled analgesia often involves combinations of multiple drugs. This study aimed to determine the stability of drug mixtures commonly used for intravenous patient-controlled analgesia. Materials and methods We examined four of the most commonly used drug combinations in intravenous patient-controlled analgesia at our institution. Mixtures contained fentanyl (400 μg), either oxycodone (10 mg) or hydromorphone (4 mg), nefopam (20 mg), and either ondansetron (10 mg) or ramosetron (0.3 mg). Each drug mixture was diluted in 0.9% saline and stored in a portable patient-controlled analgesia system at room temperature (24 °C) for 96 h. Physical attributes including color, turbidity, and precipitation were assessed using digital imaging and optical microscopy. Sterility testing was conducted to assess for microbiological contamination. The pH of each mixture was monitored for up to 96 h after mixing. The concentration of each drug in the mixture was also evaluated using high-performance liquid chromatography. Results All mixtures remained colorless and transparent with no visible sediment for 96 h. After 14 days of culture, none of the samples showed bacterial or fungal growth. The pH for all mixtures was maintained between 4.17 and 5.19, and the mean pH change in any mixture was less than 0.4 over the study period. The concentration of each drug remained between 90 and 110% of the initial value for 96 h after mixing. Conclusion Four drug mixtures commonly used for intravenous patient-controlled analgesia are physiochemically stable and remain sterile for 96 h after mixing.

BACKGROUND Post-Operative Nausea and Vomiting (PONV), is one of the most common and distressing adverse events experienced by patients after an anaesthesia and surgery. It may prolong recovery, delay patient discharge and increase hospital costs. PONV is common after laparoscopic cholecystectomy with a high incidence of 40-75%. In this study, we used conventional 5-HT3 receptor antagonist ondansetron and a newer 5-HT3 receptor antagonist, Ramosetron as a prophylaxis for PONV after laparoscopic cholecystectomy (LC) under general anaesthesia in two different groups of patients and we compared the efficacy and tolerability of the two drugs. This study was carried out to compare the efficacy of Ramosetron and Ondansetron in preventing PONV after laparoscopic cholecystectomy under general anaesthesia. METHODS This is a prospective randomized controlled study conducted among 124 adultpatients of either sex, aged between 25 and 55 yrs., of ASA physical status 1 and ii scheduled for laparoscopic cholecystectomy, who were randomly allocated into Group A (n=62) receiving (IV) Ondansetron (4 mg) and group B (n=62) receiving IV Ramosetron (0.3 mg) prior to the induction of general anaesthesia in a doubleblind manner. Episodes of PONV were noted at 0.5, 1, 2, 4, 6, 12 hours postoperatively. RESULTS Statistically significant difference between Groups A and B (p

Background Combination antiemetic therapy has become a common practice for the prevention of postoperative nausea and vomiting (PONV). The aim of the present study was to evaluate the stability and compatibility of ramosetron hydrochloride and midazolam in 0.9% sodium chloride injection when stored at 4°C and 25°C for up to 14 days. Methods Admixtures were assessed initially and for 14 days after preparation in polyolefin bags and glass bottles using 0.9% sodium chloride injection as the diluent and stored at 4°C or 25°C. The initial concentrations were 0.3 mg/100 mL ramosetron hydrochloride and 0.5 mg/100 mL midazolam hydrochloride. For all samples, the compatibility parameters (including precipitation, cloudiness, discoloration and pH values) were evaluated. Chemical stability was also determined using high-performance liquid chromatography (HPLC) analysis. Results After a 14-day period of storage at 4°C or 25°C, the percent of the initial concentration of ramosetron hydrochloride and midazolam hydrochloride in the various solutions were maintained at a minimum of 97%. All of the mixtures remained clear and colourless throughout the observation period, and no colour change or precipitation was observed. Conclusion The results indicate that admixtures of 0.3 mg/100 mL ramosetron hydrochloride and 0.5 mg/100 mL midazolam hydrochloride in normal saline were stable for 14 days at 4°C or 25°C when packaged in polyolefin bags or glass bottles and protected from light.

OBJECTIVE To investigate the effect of ramosetron after gynecological laparoscopic surgery on the recovery of bowel function. METHODS A prospective randomized controlled trial conducted at Kyung Hee University hospital, South Korea, from August 2016 to September 2017. Patients were randomized to receive either 10 mg dexamethasone before induction of anesthesia (control group C), followed by intravenous administration of patient-controlled analgesia (IV-PCA) or 2 ml normal saline before induction of anesthesia and 0.6 mg ramosetron (study group R) administered with IV-PCA. RESULTS A total of 88 patients were enrolled. Times to first flatus (group C 23.98 ± 6.31 vs. group R 27.14 ± 9.56 h; P = 0.148) and first defecation (group C 36.16 ± 16.04 vs. group R 43.41 ± 20.01 h; P = 0.138) showed no statistically significant differences. No significant differences were observed in the frequency of postoperative nausea and vomiting (PONV) and demand for additional analgesics. Multiple linear regression for analysis of factors affecting time to first flatus revealed no significant results. CONCLUSION Ramosetron did not delay bowel movement recovery after gynecologic laparoscopic surgery and was as effective as dexamethasone in regulating PONV. Ramosetron can be used with IV-PCA without concerns about delay in recovery of bowel function. ClinicalTrials.gov registration number: NCT02849483.

Background: The incidence of postoperative nausea and vomiting (PONV) remains high. The effects of sufentanil for PONV is not firmly confirmed. The aim of this study was to compare the effect of sufentanil- and fentanyl-based intravenous patient-controlled analgesia (IV-PCA) on the incidence of PONV after laparoscopic nephrectomy. Methods: Eighty-six patients were randomly allocated to receive either the sufentanil (n =43) or fentanyl (n =43). IV-PCA was prepared using either sufentanil 3 µg/kg or fentanyl 20 µg/kg, ramosetron 0.3 mg, and ketorolac 120 mg. The primary outcome of was the incidence of PONV during 24 h after post anesthesia care unit (PACU) discharge. The secondary outcomes were the modified Rhodes index and patient satisfaction scores at 24 h after PACU discharge, need for rescue antiemetics, pain score, need for additional analgesics, and cumulative consumption of IV-PCA Results: The incidence of PONV was comparable between the sufentanil and fentanyl groups (64.3% vs. 65%, p = 0.946; respectively). The number of patients who required antiemetics (p = 0.946) and the modified Rhodes index at 24 h after post-anesthesia care unit discharge (p = 0.668) were also comparable in both groups. No significant differences were found in the secondary outcomes, including the analgesic profiles and adverse events between the groups. Conclusions: In conclusion, sufentanil- and fentanyl-based IV-PCA showed similar incidence of PONV with comparable analgesic effects after laparoscopic nephrectomy. Based on these results, we suggest that sufentanil and fentanyl may provide comparable effects for IV-PCA after laparoscopic nephrectomy.

BACKGROUND Spinal anesthesia has been shown to be easy, rapid and safe technique for caesarean section. Both Ramosetron and Ondansetron are increasingly being used for prevention and treatment of nausea and vomiting. We wanted to evaluate the efficacy of Ramosetron and Ondansetron in prevention of nausea and vomiting intraoperatively and postoperatively in LSCS patients under spinal anesthesia. METHODS This was a randomized, double blind study conducted among 60 female patients. They received either Ondansetron (4 mg) or Ramosetron (0.3 mg) intravenously 10 minutes before administration of spinal anesthesia. All patients were subjected to elective caesarean section under spinal anesthesia. They were randomly allocated into two groups namely control group (A) 30 patients who received Inj. Ondansetron 4 mg/IV and study group (B) of 30 patients who received Ramosetron 0.3 mg/IV. The patients were observed intraoperatively, in the recovery room and the ward up to 24 hours for episodes of nausea and vomiting. Rescue anti emetic was given if PONV score 2 was recorded. Side effects such as dizziness, headache, sedation or extrapyramidal reaction were noted. RESULTS Nausea and vomiting were noticed in 33.3% of the control group compared to 20% of the study group. Rescue antiemetic with PONV score 2 was given to 13.3% and 6.66% of the control and study groups respectively. Side effects were minimal with satisfaction expressed by 60% of control and 80% of the study population. CONCLUSIONS Ramosetron is quite effective to prevent nausea and vomiting in LSCS patients under spinal anaesthesia. It reduces the incidence of nausea and vomiting intraoperatively and in the immediate postoperative period with minimal side effects and with good patient satisfaction.

Introduction: The incidence of postoperative nausea and vomiting (PONV) following laparoscopic surgeries is very high without antiemetic prophylaxis. 5HT3 receptor antagonists are the most commonly used drug for prevention of PONV. Aims: To compare the effectiveness of intravenous (IV) palonosetron versus ramosetron in prevention of PONV during the 24 hour period in patients undergoing laparoscopic surgeries. Materials and Methods: Sixty patients enrolled for the study were randomly allotted into two groups of thirty each. Group I received 0.075 mg of IV palonosetron and Group II received 0.3 mg of IV ramosetron two minutes before induction of anaesthesia. Both the Groups were similar with respect to age, sex, duration and types of surgery and anaesthetic management. Patients were assessed for the incidence of nausea, retching, vomiting, need for rescue antiemetic and adverse effects at 0-2 hour and 2-24 hours interval following surgery. Students ‘t’ test and chi-square test were used for comparing the parameters. A p-value Results: There was no significant difference between the groups with respect to incidence of nausea, retching and vomiting. The incidence of nausea in group I at 0-2 hours was 3.3% and 6.7% in Group II without a statistically significant difference (p=0.5) and at 2-24 hour interval Group I had 3.3% while Group II had 10% incidence of vomiting with p=0.3 and statistically non-significant. There was no significant difference with respect to incidence of retching, vomiting, need for rescue antiemetic and adverse effects between the two groups. Conclusion: Both palonosetron and ramosetron are equally effective in prevention of PONV in laparoscopic surgeries. Keywords: Laparoscopic surgery, Nausea, Palonosetron, Ramosetron, Retching, Vomiting.

Background/Aims: The aim of this study was to determine the correlation between low-dose ramosetron pretreatment and gastric emptying using a novel, non-invasive technique for measuring gastric emptying, namely, the continuous real-time 13C breath test (BreathID system: Exalenz Bioscience Ltd., Israel). Materials and Methods: Twelve healthy male volunteers participated in this randomized two-way crossover study. The subjects fasted overnight and were randomly assigned to receive the test meal (200 kcal per 200 mL) after an hour pre-treatment with 5 µg ramosetron or the test meal alone. Gastric emptying was monitored for 4 hours after administration of the test meal with the 13C-acetic acid breath test performed continuously using the BreathID system. Using Oridion Research Software (β version), T 1/2, T lag, GEC and the regression-estimated constants (β and κ) were calculated. The differences in the parameters measured at two time-points were analyzed using Wilcoxon’s signed-rank test. Results: There was a significant difference in the calculated parameter β. No significant differences in the calculated parameters T 1/2, T lag, GEC or κ were observed between the test meal with ramosetron group and the test meal alone group. Conclusion: This study showed that ramosetron pre-treatment enhances the early gastric emptying of liquid nutrients.

ObjectiveOver half of patients with IBS have either diarrhoea (IBS-D) or a mixed stool pattern (IBS-M). The relative efficacy of licenced pharmacological therapies is unclear in the absence of head-to-head trials. We conducted a network meta-analysis to resolve this uncertainty.DesignWe searched MEDLINE, Embase, Embase Classic, the Cochrane central register of controlled trials, and Clinicaltrials.gov through January 2019 to identify randomised controlled trials (RCTs) assessing the efficacy of licenced pharmacological therapies (alosetron, eluxadoline, ramosetron and rifaximin) in adults with IBS-D or IBS-M. Trials included in the analysis reported a dichotomous assessment of overall response to therapy, and data were pooled using a random effects model. Efficacy and safety of all pharmacological therapies were reported as a pooled relative risk with 95% CIs to summarise the effect of each comparison tested. Treatments were ranked according to their p score.ResultsWe identified 18 eligible RCTs (seven alosetron, five ramosetron, two rifaximin and four eluxadoline), containing 9844 patients. All were superior to placebo for the treatment of IBS-D or IBS-M at 12 weeks, according to the Food and Drug Administration (FDA)-recommended endpoint for trials in IBS. Alosetron 1 mg twice daily was ranked first for efficacy, based on the FDA-recommended composite endpoint of improvement in both abdominal pain and stool consistency, effect on global symptoms of IBS and effect on stool consistency. Ramosetron 2.5µg once daily was ranked first for effect on abdominal pain. Total numbers of adverse events were significantly greater with alosetron 1 mg twice daily and ramosetron 2.5µg once daily, compared with placebo. Rifaximin 550 mg three times daily ranked first for safety. Constipation was significantly more common with all drugs, except rifaximin 550 mg three times daily.ConclusionIn a network meta-analysis of RCTs of pharmacological therapies for IBS-D and IBS-M, we found all drugs to be superior to placebo, but alosetron and ramosetron appeared to be the most effective.

Background The fragility index (FI) represents the number of participants whose status in a trial would have to change from a non-event (not experiencing the primary endpoint) to an event (experiencing the primary endpoint) in order to turn a statistically significant result into a non-significant result. We sought to evaluate the fragility indices of irritable bowel syndrome [IBS-mixed (IBS-M), IBS-constipation (IBS-C), & IBS-diarrhea (IBS-D)] trials. Methods Irritable bowel syndrome trials published in high-impact journals were identified from Medline. Trials had to be in adults, randomized, parallel-armed, with at least one statistically significant binary outcome, and an achieved primary endpoint of therapeutic efficacy. FI and correlation coefficients were calculated, and regression modeling used to identify predictors of a high FI. Key results Twelve trials were analyzed with a median FI of 6 (range: 0-38). Median sample size in all trials was 366 (range: 44-856). Trial publication year (p = 0.71), journal impact factor (p = 0.52), duration of study (p = 0.12), and number need to treat [NNT] (p = 0.29) were not predictive of a high FI. While a lower p-value correlated with a higher FI (p = 0.039), no correlation was noted between FI and impact factor (R = -0.20, p = 0.52), trial publication year (R = 0.12, p = 0.71), duration of trial (R = -0.46, p = 0.13), NNT (R = -0.34, p = 0.29), and sample size (R = 0.23, p = 0.5). The highest FI was in a Ramosetron trial (FI = 30) for IBS-D. Conclusion & inferences A median of six participants is needed to nullify results in the included IBS trials suggesting how easily statistical significance based on a threshold p-value may be overturned.

Postoperative nausea and vomiting is a common adverse effect of anaesthesia. Although dozens of different anti-emetics are available for clinical practice, there is currently no comparative ranking of efficacy and safety of these drugs to inform clinical practice. We performed a systematic review with network meta-analyses to compare, and rank in terms of efficacy and safety, single anti-emetic drugs and their combinations, including 5-hydroxytryptamine3, dopamine-2 and neurokinin-1 receptor antagonists; corticosteroids; antihistamines; and anticholinergics used to prevent postoperative nausea and vomiting in adults after general anaesthesia. We systematically searched for placebo-controlled and head-to-head randomised controlled trials up to November 2017 (updated in April 2020). We assessed how trustworthy the evidence was using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Confidence In Network Meta-Analysis (CINeMA) approaches for vomiting within 24 h postoperatively, serious adverse events, any adverse event and drug class-specific side-effects. We included 585 trials (97,516 participants, 83% women) testing 44 single drugs and 51 drug combinations. The studies' overall risk of bias was assessed as low in only 27% of the studies. In 282 trials, 29 out of 36 drug combinations and 10 out of 28 single drugs lowered the risk of vomiting at least 20% compared with placebo. In the ranking of treatments, combinations of drugs were generally more effective than single drugs. Single neurokinin-1 receptor antagonists were as effective as other drug combinations. Out of the 10 effective single drugs, certainty of evidence was high for aprepitant, with risk ratio (95%CI) 0.26 (0.18–0.38); ramosetron, 0.44 (0.32–0.59); granisetron, 0.45 (0.38–0.54); dexamethasone, 0.51 (0.44–0.57); and ondansetron, 0.55 (0.51–0.60). It was moderate for fosaprepitant, 0.06 (0.02–0.21) and droperidol, 0.61 (0.54–0.69). Granisetron and amisulpride are likely to have little or no increase in any adverse event compared with placebo, while dimenhydrinate and scopolamine may increase the number of patients with any adverse event compared with placebo. So far, there is no convincing evidence that other single drugs effect the incidence of serious, or any, adverse events when compared with placebo. Among drug class specific side-effects, evidence for single drugs is mostly not convincing. There is convincing evidence regarding the prophylactic effect of at least seven single drugs for postoperative vomiting such that future studies investigating these drugs will probably not change the estimated beneficial effect. However, there is still considerable lack of evidence regarding safety aspects that does warrant investigation.

Patients who undergo multiple-day chemotherapy sessions experience hard-to-treat nausea and vomiting. Currently, there is no effective standard treatment for this condition. This study compared the preventive effect of first-generation 5-hydroxytryptamine 3 receptor antagonists (5-HT3 RAs) and second-generation 5-HT3 RAs palonosetron in multiple-day chemotherapy-induced nausea and vomiting. The design of this study was a retrospective case-control study of patients who received a five-day cisplatin-based chemotherapy and were treated with aprepitant, dexamethasone, granisetron, and ramosetron or palonosetron. The patients were divided into two groups: patients given granisetron and ramosetron (the first-generation group), and those given palonosetron (palonosetron group). The percentage of patients with a complete response or total control was assessed. They were divided into three phases: 0-216 h (overall phase), 0-120 h (remedial phase), and 120-216 h (after phase). The remedial phase was further divided into 0-24 h (early phase) and 24-120 h (later phase). Moreover, the nutritional status of each patient was assessed by noting the patients' total calorie-intake per day and total parenteral nutrition. First-generation 5-HT3 RAs and palonosetron were used for treatment in 18 and 28 patients, respectively. The complete response rate and caloric oral intake of the later phase were higher in the palonosetron group than in the first-generation group. We conclude that palonosetron treatment was more effective than first-generation 5-HT3 RAs in controlling multiple-day chemotherapy-induced nausea and vomiting.

Background and Objectives: We investigated the non-inferiority of patient-controlled analgesia (PCA), using either nefopam alone or combined nefopam-fentanyl for postoperative analgesia in patients undergoing laparoscopic cholecystectomy. Materials and Methods: In this prospective, randomized, controlled study, 78 patients were allocated to receive nefopam 240 mg (Group N240) or nefopam 120 mg with fentanyl 600 μg (Group NF), equivalent to fentanyl 1200 μg, with a total PCA volume of 120 mL. Patients were given a loading dose (0.1 mL/kg) from the PCA device along with ramosetron (0.3 mg) and connected to a PCA device with a background infusion rate of 2 mL/h, bolus dose amount set at 2 mL, and lockout interval set at 15 min. Pain scores were obtained using the numeric rating scale (NRS) at 30 min after recovery room (RR) admission, as well as 8 and 24 h postoperatively. The primary outcome was analgesic efficacy evaluated using NRS-rated 8 h postoperatively. Other evaluated outcomes included the incidence rate of bolus demand, rescue analgesic and antiemetic requirements, and postoperative adverse effects. Results: NRS scores were not significantly different between the groups throughout the postoperative period (p = 0.539). NRS scores of group N240 were not inferior to those of group NF at 30 min after RR admission, or at 8 and 24 h postoperatively (mean difference [95% CI], −0.05 [−0.73 to 0.63], 0.10 [−0.29 to 0.50], and 0.28 [−0.06 to 0.62], respectively). Postoperative adverse effects were not significantly different between the two groups (p = 1.000) and other outcomes were also not significantly different between the two groups (p ≥ 0.225). Conclusion: PCA using nefopam alone has a non-inferior and effective analgesic efficacy and produces a lower incidence of postoperative adverse effects compared to a combination of fentanyl and nefopam after laparoscopic cholecystectomy.

Objective To determine the effectiveness of pharmacologic interventions for preventing postoperative nausea and vomiting (PONV) in patients undergoing thyroidectomy. Design Systematic review and network meta-analysis (NMA). Data sources MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar. Eligibility criteria, participants, and interventions Randomized clinical trials that investigated the efficacy of pharmacologic interventions in preventing PONV in patients undergoing thyroidectomy were included. The primary endpoints were the incidences of postoperative nausea and vomiting (PONV), postoperative nausea (PON), postoperative vomiting (POV), use of rescue antiemetics, and incidence of complete response in the overall postoperative phases. The secondary endpoints were the same parameters assessed in the early, middle, and late postoperative phases. The surface under the cumulative ranking curve (SUCRA) values and rankograms were used to present the hierarchy of pharmacologic interventions. Results Twenty-six studies (n = 3,467 patients) that investigated 17 different pharmacologic interventions were included. According to the SUCRA values, the incidence of PONV among the overall postoperative phases was lowest with propofol alone (16.1%), followed by palonosetron (27.5%), and with tropisetron (28.7%). The incidence of PON among the overall postoperative phases was lowest with propofol alone (11.8%), followed by tropisetron and propofol combination (14%), and ramosetron and dexamethasone combination (18.0%). The incidence of POV among the overall postoperative phases was lowest with tropisetron and propofol combination (2.2%), followed by ramosetron and dexamethasone combination (23.2%), and tropisetron alone (37.3%). The least usage of rescue antiemetics among the overall postoperative phases and the highest complete response was observed with tropisetron and propofol combination (3.9% and 96.6%, respectively). Conclusion Propofol and tropisetron alone and in combination, and the ramosetron and dexamethasone combination effectively prevented PONV, PON, POV in patients undergoing thyroidectomy, with some heterogeneity observed in this NMA of full-text reports. Their use minimized the need for rescue antiemetics and enhanced the complete response. Trial registration number CRD42018100002.

Background There is evidence demonstrating the beneficial effects of 5-hydroxytryptamine 3 receptor antagonists (5-HT3) for the treatment of non-constipated irritable bowel syndrome (NC-IBS). We aimed to determine the comparative effectiveness of 5-HT3 antagonists in NC-IBS, as evidenced by the results of a network meta-analysis (NWM) of published relevant randomized controlled trials (RCTs). Methods We searched the PubMed/Medline, EMBASE, and Cochrane Library databases for relevant RCTs through September 2020 and data from each selected RCT were extracted. A Bayesian NWM was then performed to investigate the efficacy of 5-HT3 antagonists and to explore the effectiveness rank order in treating NC-IBS patients. Results Twenty-one eligible RCTs were identified and entered into this NWM. They included a total of 10,421 NC-IBS patients, randomized to alosetron, cilansetron, ondansetron, ramosetron, placebo, and mebeverine. The cumulative ranking probability for each intervention at the end of treatment period, was evaluated by means of surfaces under cumulative ranking (SUCRA) values. These results showed that alosetron had the best performance for global symptom improvement (SUCRA 0.82), cilansetron showed the best performance (SUCRA 0.90) for abdominal pain/discomfort improvement, while ondansetron (SUCRA 0.98) was by far the best choice concerning bowel habits/consistency improvement. The control regimens (mebeverine and placebo) represented the least efficacious interventions. Conclusions This NWM showed that 5-HT3 receptor antagonists performed better in comparison to control drugs. Consequently, this class of drugs may play an important role in improving the debilitating symptoms in NC-IBS patients, in particular those with diarrhea.

In this study, a new strategy for the simultaneous quantization of five serotonin 5-hydroxytryptamine receptor antagonists—ondansetron, azasetron, ramosetron, granisetron, and tropisetron—either in infusion samples or in injection dosage form was first established based on high-performance liquid chromatography combined with a quantitative analysis of multiple components by a single marker. The quantitative analysis of multicomponents by a single marker method was conducted with ondansetron as an internal reference substance and performed using relative retention time and ultraviolet spectral similarity as the double indicator. The quantitative analysis of the 5-HT3 receptor antagonists was calculated and investigated based on the relative correction factors. Chromatographic separation was achieved using a C18 column (150 mm × 4.6 mm, 5.0 μm), and the mobile phase was composed of acetonitrile-0.05 mol·L−1 potassium dihydrogen phosphate (pH 4.0) (25 : 75) at a flow rate of 1.0 mL·min−1 and detection wavelengths of 307 nm (ondansetron, azasetron, ramosetron), 302 nm (granisetron), and 285 nm (tropisetron). In addition, the accuracy of the quantitative analysis of multicomponents by a single marker method was compared with an external standard method, and no significant difference was observed between the two methods. The established method is rapid, is easy, and does not require many reference substances, and it can been successfully applied as part of the quality control of the five 5-HT3 receptor antagonists in their injection dosage form and infusion sample drugs in hospitals.

Background Arthroscopic rotator cuff repair is a painful procedure, and treatment of emetic events associated with drugs used in the current multimodal pain management remains challenging. This study aimed to evaluate the effectiveness of ramosetron or ondansetron to relieve postoperative nausea and vomiting (PONV) and pain after arthroscopic rotator cuff repair. Methods In total, 122 consecutive patients undergoing arthroscopic rotator cuff repair were randomly allocated into three groups: ramosetron group (n = 39), ondansetron group (n = 43), and control group (n = 40). Then, 0.3 mg of ramosetron or 8 mg of ondansetron was administered intravenously at the end of surgery according to group. All patients received general anesthesia and multimodal pain management protocol including preemptive analgesic medication, fentanyl-based intravenous patient-controlled analgesia, and postoperative analgesic medication. Incidence of emetic events, rescue antiemetic requirements (10 mg of metoclopramide, IV), complete response, pain level, and side effects were recorded in three periods: 0–6, 6–24, and 24–48 h postoperatively. The severity of nausea and pain was evaluated using a visual analog scale. Results The ramosetron group tended to have a lower incidence and severity of nausea during the 6- to 24-h postoperative period and fewer rescue antiemetic drug requirements during the 0- to 48-h period than the control group, showing statistical significance. Additionally, the frequency of complete response of the ramosetron and ondansetron groups was significantly higher than that of the control group. No difference was found among the groups in the pain level except during the 0- to 6-h period. The two groups have a higher complete response during the 6- to 24-h period than the control group. Conclusions Ramosetron use led to a lower incidence, mild severity of nausea, and reduced use of rescue antiemetic drug after arthroscopic rotator cuff repair during the 6- to 24-h postoperative period than the control. Level of evidence Level I, randomized controlled trials, treatment study

Background No effective treatment exists for anterior resection syndrome (ARS) following sphincter-saving surgery for rectal cancer. This RCT assessed the safety and efficacy of a 5-HT3 receptor antagonist, ramosetron, for ARS. Methods A single-centre, randomized, controlled, open-label, parallel group trial was conducted. Male patients with ARS 1 month after rectal cancer surgery or ileostomy reversal were enrolled and randomly assigned (1 : 1) to 5 μg of ramosetron (Irribow®) daily or conservative treatment for 4 weeks. Low ARS (LARS) score was calculated after randomization and 4 weeks after treatment. The study was designed as a superiority test with a primary endpoint of the proportion of patients with major LARS between the groups. Primary outcome analysis was based on the modified intention-to-treat population. Safety was assessed by monitoring adverse events during the study. Results A total of 100 patients were randomized to the ramosetron (49 patients) or conservative treatment group (51 patients). Two patients were excluded, and 48 and 50 patients were analysed in the ramosetron and control groups, respectively. The proportion of major LARS after 4 weeks was 58 per cent (28 of 48 patients) in the ramosetron group versus 82 per cent (41 of 50 patients) in the control group, with a difference of 23.7 per cent (95 per cent c.i. 5.58 to 39.98, P = 0.011). There were minor adverse events in five patients, which were hard stool, frequent stool or anal pain. These were not different between the two groups. There were no serious adverse events. Conclusion Ramosetron could be safe and feasible for male patients with ARS. Trial registration number NCT02869984 (http://www.clinicaltrials.gov).

Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction which can have a considerable impact on quality of life. Following diagnosis, timely and evidence-based management is vital to the care of patients with IBS, aiming to improve outcomes, and enhance patient satisfaction. Good communication is paramount, and clinicians should provide a clear explanation about the disorder, with a focus on exploring the patient’s own beliefs about IBS, and a discussion of any concerns they may have. It should be emphasised that symptoms are often chronic, and that treatment, while aiming to improve symptoms, may not relieve them completely. Initial management should include simple lifestyle and dietary advice, discussion of the possible benefit of some probiotics, and, if this is unsuccessful, patients can be referred to a dietician for consideration of a low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet. Antispasmodics and peppermint oil can be used first-line for the treatment of abdominal pain. If patients fail to respond, central neuromodulators can be used second-line; tricyclic antidepressants should be preferred. Loperamide and laxatives can be used first-line for treating diarrhoea and constipation, respectively. Patients with constipation who fail to respond to laxatives should be offered a trial of linaclotide. For patients with diarrhoea, the 5-hydroxytryptamine-3 receptor agonists alosetron and ramosetron appear to be the most effective second-line drugs. Where these are unavailable, ondansetron is a reasonable alternative. If medical treatment is unsuccessful, patients should be referred for psychological therapy, where available, if they are amenable to this. Cognitive behavioural therapy and gut-directed hypnotherapy are the psychological therapies with the largest evidence base.

Ramosetron is an enantiopure active pharmaceutical ingredient marketed in Japan since 1996 and later in a few Southeast Asian countries predominantly as an antiemetic for patients receiving chemotherapy. In this study, a simple and rapid high-performance liquid chromoatography method for the separation of ramosetron and its related enantiomeric impurity by using hydrophilic interaction liquid chromatography mode is presented. Chiral resolution was performed on an analytical column (100 mm × 4.6 mm id) packed with 3 μm particles of cellulose-based Chiralpak IC-3 chiral stationary phase. Using a mobile phase containing acetonitrile-water-diethylamine (100:10:0.1, v/v/v) and setting the column temperature at 35°C, the resolution value was 7.35. At a flow rate of 1 mL/min, the enantioseparation was completed within 5 min. The proposed method was partially validated and it has proven to be sensitive with limit of detection and limit of quantitation of the (S)-enantiomer impurity of 44.5 and 133.6 ng/mL.

Ramosetron hydrochloride is the hydrochloride salt of ramosetron, a selective serotonin (5-HT3) receptor antagonist with potential antiemetic activity. Upon administration, ramosetron selectively binds to and blocks the activity of 5-HT subtype 3 (5-HT3) receptors located in the vagus nerve terminal and the vomiting center of central nervous system (CNS), suppressing chemotherapy-induced nausea and vomiting. Degradation of Ramosetron HCl was conducted with 0.1N NaOH at 60°C, 70°C and 80°C to study the reaction kinetics. The reaction rate constants (k) for degradation at 60°C, 70°C and 80°C were -2.2680 molL-1s-1 , -3.3714 molL-1s-1 and -5.3686 molL-1s-1 for zero order and -1.05 x 10-2s-1, -1.60 x 10-2s-1 and -2.70 x 10-2s-1 for first order kinetics, respectively. The activation energy of Ramosetron HCl was found as 10.05 kcalmol-1 by using Arrhenius equation. Dhaka Univ. J. Pharm. Sci. 17(2): 167-173, 2018 (December)

Irritable bowel syndrome (IBS), a common gastrointestinal (GI) disorder, is associated with various factors, including lifestyle, infection, stress, intestinal flora, and related diseases. The pharmacotherapeutic stimulation of receptors and downstream signaling pathways is effective in reducing IBS symptoms; however, it is still associated with adverse effects. Various receptors related to GI motility and visceral hypersensitivity should be considered to enhance the benefit/risk ratio of IBS treatments. This review discusses recent pharmacological advances in IBS management. Several receptors related to GI motility and abdominal pain are investigated in various angles. 5-Hydroxytryptamine (5-HT) is an important neurotransmitter that activates the colonic mucosal 5-HT4 receptor without causing severe cardiovascular adverse effects. The clinical potential of ramosetron for diarrhea-predominant IBS has been suggested because of a lower risk of ischemic colitis than conventional 5-HT3 receptor antagonists. Toll-like receptors (TLRs), especially TLR2 and TLR4, show a significant effect on the post-infection symptoms and lipopolysaccharide-mediated regulation of GI motility. Histamine is a well-known nitrogenous compound that regulates inflammatory responses and visceral hypersensitivity. Histamine 1 receptor-mediated sensitization of the transient receptor potential vanilloid 1 is associated with IBS. Pharmacological approaches based on these signaling pathways could be useful in the development of novel IBS treatments.

Three issues of fundamental importance in drug therapy are safety, efficacy and stability. Extensive information derived from stress degradation studies of Ramosetron HCl will expand the scientific thought further to ensure to achieve the intended quality of Ramosetron HCl as drug substance and drug products available in the market. Stress degradation screening of Ramosetron HCl was conducted in aqueous, 0.1N, 0.5N, 1.0N and 2.0N acid-base and oxidative (3, 5 and 10 % H2O2) conditions and photo degradation. No degradation was found in aqueous condition at 60°C for 7 days. Acceptable degradations were found in 0.5 N, 1N and 2N HCl at 70ºC for 7 days, 0.1N NaOH at 60°C for 2 days, 3% hydrogen peroxide at room temperature for 1, 2 and 3 hours in dark and 3.6 million lux fluorescence light or 600 watts hour/m2 UV light. Among other applied stress conditions, the base hydrolysis and oxidative methods degraded Ramosetron hydrochloride more drastically than the other stressed conditions.Dhaka Univ. J. Pharm. Sci. 17(1): 9-17, 2018 (June)

BACKGROUND 5-HT3 receptor antagonists have potent antiemetic effect in chemotherapy induced nausea and vomiting. The present study was conducted to study and compare the efficacy and safety of ramosetron, palonosetron and granisetron in preventing acute and delayed nausea and vomiting in cancer patients receiving moderately emetogenic chemotherapy, and the impact of these drugs on daily living of these patients. MATERIALS AND METHODS It was an open label, randomised, prospective, comparative, parallel study. A total of 59 patients were enrolled in the study. They were divided into 3 groups: palonosetron (0.25mg i.v and 0.5mg orally daily; n=18) group, ramosetron (0.3 mg i.v and 0.1 mg orally daily; n=22) group, and granisetron (1mg i.v and 2mg orally daily; n=19). The drugs were given for 5 days after chemotherapy cycle. In addition, all the three groups received inj. dexamethasone (16mg) prior to chemotherapy and tab. domperidone 10mg orally before chemotherapy and 3 times daily till day 5. The incidence and severity of nausea and vomiting, use of rescue antiemetics and the impact on daily living were evaluated for 7 days. Emetic episodes were recorded on a diary on a daily basis and nausea was measured on a visual analogue scale. Complete response rates (no emesis and no need of rescue antiemetics) were measured as the primary end point. The quality of life outcomes were measured using the functional life index – emesis (FLIE) questionnaire. Safety was evaluated by monitoring the adverse drug reactions of the test drugs. RESULTS The complete response rate in ramosetron group (72.7% in acute; 68.2% in delayed) were numerically better than palonosetron (66.7%; 61.1%) and granisetron (42.1%; 36.8%). The results didn’t achieve statistical significance. The impact on daily living was numerically better in ramosetron than palonosetron and granisetron but the results didn’t show a statistical significance. All the three drugs were well tolerated. CONCLUSION All the three drugs were effective and well tolerated. However, ramosetron showed numerically better complete response rates and better quality of life outcomes as compared to palonosetron and granisetron.

Colorectal cancer ranks as the third most common type of cancer in the world. One of the most common types of surgery instituted to eliminate cancer lesion in the lower rectum is low anterior resection.1 About one-third patients develop low anterior resection syndrome/ anterior resection syndrome (LARS/ARS) following this surgery, which comprises of painful defecation, stool urgency and frequency, inability to discriminate between flatus and stool, diaper dependency, difficulty holding stools as well as incontinence which leads to extremely poor quality of life.1 Surgery, as well as the radiotherapy, is inflicted in the development of this syndrome since both results in some form of damage to the innervations of the anal sphincter and rectum.2 Neo-rectum produced from surgery cannot also hold stool for long, which also contributes to the symptoms of this syndrome.2 Anterior resection syndrome often fails to remit and becomes a chronic ailment for the colorectal cancer survivors, thus causing significant malfunction and distress to their lives.3 Very little research has focused on the management of LARS/ARS. Symptoms of LARS/ARS seem to resemble that of diarrhoea- predominant irritable bowel syndrome (IBS-D) and studies have shown that these symptoms may be the result of altered expression of serotonin receptors.4,5 Ryohei Itagaki et al. in their clinical trial demonstrated the efficacy of 5-HT3 receptor antagonists in reducing symptoms of LARS/ARS.5 In this small trial a 5-HT3 receptor antagonist, ramosetron was given to the patients for one month and noticed that it produced significant reductions in stool urgency as well as the number of stools per day.5 These results indicate that therapeutic options which have demonstrated efficacy against IBS-D such as 5-HT3 receptor antagonists and opioid receptor agonists may prove efficacious in reducing symptoms of LARS/ARS.6 Loperamide has since long proven to be a potent anti-diarrhoeal agent and has established its efficacy in treating IBS-D in several clinical trials.7 In a double-blind clinical trial conducted by P S Efskind et al, loperamide produced improvement in stool consistency and frequency throughout the five weeks of treatment in patients with IBS-D.7 Continuous...

This randomized trial investigated whether a 2-dose administration of intravenous ramosetron (5-hydroxytryptamine type 3 receptor antagonist) is more effective than a single-dose administration in preventing postoperative nausea and vomiting (PONV) in 89 patients who were scheduled to undergo laparoscopic operation for benign gynecologic diseases and to receive intravenous patient-controlled analgesia for relief of postoperative pain. After assignment at a ratio of 1:1, intravenous ramosetron (0.3 mg) was initially administered at the end of skin closure in all patients. Thereafter, ramosetron (0.3 mg) and placebo were administered to the study and control groups, respectively, at 4 hours after the operation. The baseline and operative characteristics were similar between the groups. The incidence of PONV during the 24-hour period after operation which was assessed as the primary endpoint did not differ between the groups. No serious adverse events occurred in either group. A 2-dose administration of intravenous ramosetron may not be superior to a single-dose administration in preventing PONV in patients undergoing laparoscopic operation for benign gynecologic diseases.

Introduction Postoperative nausea and vomiting (PONV) is a well-known entity following surgical procedures and may result in serious complications including aspiration of gastric contents, prolonged recovery period, and impaired surgical wound healing. Laparoscopic surgery is a known risk factor for PONV. Also, the incidence of vomiting after ear nose throat (ENT) surgeries is relatively high. Aims and Objectives Our aim of the study is to compare the effectiveness of ondansetron, palonosetron, ramosetron, and metoclopramide to prevent PONV in patients undergoing laparoscopic and ENT surgery under general anesthesia. Materials and methods The present study was conducted on 120 adult patients scheduled for elective laparoscopic chole­cystectomy and ENT surgery under general anesthesia. All patients were randomized into four groups (O, P, R, and M) with 30 patients each and received injection ondansetron (4 mg), palonosetron (0.075 mg), ramosetron (0.3 mg), and metoclopramide (10 mg) intravenously during premedication. Patients were observed intraoperatively and 24 hours postoperatively for any episodes of nausea and vomiting. All the patients were observed for side effects, such as dizziness, headache, allergic reactions, etc. Conclusion Palonosetron is quite effective in prevention of PONV compared with ramosetron, ondansetron, and metoclopramide given intravenously for various surgical procedures under general anesthesia. Its effectiveness in PONV provides a new cost-effective agent to the present recital of antiemetic drugs. How to cite this article Vinay V, Agrawal AP, Verma AP, Krishan G, Ahmad R, Hanjura S. A Clinical Comparative Study of Ondansetron, Palonosetron, Ramosetron, and Metoclopramide for Prevention of Postoperative Nausea and Vomiting in Patients undergoing Laparoscopic and ENT Surgery under General Anesthesia. Int J Adv Integ Med Sci 2017;2(2):65-69.

Background Spinal anesthesia with intrathecal morphine is a reliable, easy to apply, and cost effective method for controlling pain after total knee arthroplasty (TKA). However, postoperative nausea and vomiting (PONV) is a major concern. 5-Hydroxytryptamine receptor 3 (5-HT 3 ) antagonists like ondansetron and ramosetron are commonly used for preventing PONV, but the optimal choice remains unclear. We conducted a study to assess the effectiveness of ramosetron and ondansetron, hypothesizing that the longer acting ramosetron may be better than ondansetron in the first 48 hours after TKA, performed with spinal anesthesia and intrathecal morphine. Methods Patients were randomized preoperatively to either intravenous ondansetron (8 mg) or ramosetron (0.3 mg). The primary outcomes were the incidence rates of PONV. Secondary outcomes were the need for a rescue antiemetic (metoclopramide), pain score, patient satisfaction, and adverse drug reactions (ADRs) at 0-6, 6-12, 12-24, and 24-48 hours. Results Ninety patients were evaluable; 45 patients/arm. Compared with ondansetron, ramosetron was associated with significantly lower incidence rates of nausea at: (1) 12-18 hours: 3/45 vs 11/45 ( P = .016), (2) 18-24 hours: 1/45 vs 9/45 ( P = .005), and vomiting at 18-24 hours: 1/45 vs 6/45 ( P = .044). There were no significant differences in the use of rescue-antiemetic medicine, pain score, patient satisfaction, and ADRs. Conclusion Preoperative ramosetron provided more prolonged PONV prophylaxis than ondansetron after TKA in our setting, and had a similar ADR profile. Other trials are needed to confirm our results before ramosetron is adopted widely.

Introduction: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder which represents a major cost to healthcare services. IBS-D patients represent about one-third of the IBS population and are currently treated with antispasmodics, loperamide, bile acid sequestrants and antidepressants. Alosetron and rifaximin are also available in USA, ramosetron in Japan, Korea and Thailand and ondansetron as an off-label treatment.Areas covered: This article focuses on eluxadoline, a novel pharmacological agent that has recently been approved by both the FDA and EMA for treatment of patients with IBS-D.Expert commentary: The efficacy and safety of eluxadoline in treating bowel habit alterations and pain, both in the short and long-term, make the drug a welcome addition to our therapeutic alternatives in IBS-D. Its positioning in any IBS algorithm will depend on the ‘real world’ prevalence of the small risk of sphincter of Oddi spasm and mild pancreatitis.

Background: There is uncertainty about the effect of antiemetic drugs (AED) for the prophylaxis of postoperative nausea and vomiting (PONV) after craniotomy. In this study, we assessed the effectiveness and safety of AED for PONV. Methods and Findings: We searched online databases including the Cochrane Library, PubMed, Wiley, Elsevier Science Direct, Ovid LWW, and Springer for publications from 1985 to June 2018. Adults undergoing craniotomy with the prophylactic use of at least one AED were included. The primary outcomes were the incidence of postoperative nausea (PON) and postoperative vomiting (POV) during the first and second day. A total of 1,433 participants from 17 clinical trials were enrolled in this Network Meta-Analysis (NMA). Compared to placebo, ramosetron was the most effective treatment for PON 24 h after surgery (OR = 0.063, 95% Crl: 0.006–0.45), with a 69.2% probability. On the other hand, for POV, droperidol was the best treatment during the first 2 h with a 71.1% probability (OR = 0.029, 95% Crl: 0.003–0.25); while fosaprepitant was the most effective treatment at 0–24 h (OR = 0.027, 95% Crl: 0.007–0.094; 66.9% probability) and 0–48 h (OR = 0.036, 95% Crl: 0.006–0.18; 56.6% probability). Besides, ramosetron showed a significantly higher incidence of complete response (OR = 29. 95% Crl: 1.4–6.5e + 02), as well as lower requirement for rescue AED (OR = 0.022, 95% Crl: 0.001–0.2). Granisetron was associated with the lowest incidence of headache and excessive sedation. Conclusions: Compared with placebo, ramosetron appears to be the best prophylactic treatment for PON 24 h after craniotomy, with higher complete responses. Fosaprepitant appears to be the most effective prophylaxis option for POV on the first 0–24 and 0–48 h. Both may be better applied in combination with perioperative dexamethasone. These findings may guide clinicians to provide improved pharmacological prophylaxis for PONV after craniotomy with fewer adverse effects.

For years pharmacotherapy in irritable bowel syndrome (IBS) was based on laxatives or anti-diarrheals accompanied by anti-spasmodics and pain killers. Nowadays, there are several attempts to target the pathways that participate in the proper functioning of the GI tract, i.e. secretagogues (linaclotide or lubiprostone), opioid receptor ligands (eluxadoline), and serotoninergic receptor ligands (alosetron, ramosetron, prucalopride). In this chapter we focus on the efficacy of drugs currently used in IBS. Moreover, we discuss the possible therapeutic options and their future perspectives

Background: The present study was conducted to compare efficacy of ondansetron and ramosetron in controlling propofol-induced pain. Materials & Methods: The present study was conducted on 56 patients of both genders. Patients were divided into 2 groups of 28 each. Group I received 4 mg of ondansetron and group II received 0.3 mg of ramosetron. All the pre-treatment drugs were made into 2 ml volume with normal saline. After intravenous (IV) pre-treatment of study drug, manual occlusion of venous drainage was done at mid-arm for 1 min. This was followed by administration of propofol (1%) after release of venous occlusion. Pain was assessed with a four‑point scale. Results: Out of 56 patients, group I received ondansetron and group II received ramosetron. Pain score 1 was seen in 4 in group I and 7 in group II, score 2 was seen in 8 in group I and 12 in group II, score 3 was seen in 10 in group I and 7 in group II and score 4 was seen in 6 in group I and 2 in group II. The difference was significant (P< 0.05). Conclusion: Authors found that 0.3 mg of Ramosetron is better than 4 mg of ondansetron in controlling propofol induced pain.

Background To date, there has been no established protocol regarding the timing of the scheduled administration of antiemetics in total knee arthroplasty (TKA). Previous prospective studies analyzing the scheduled use of antiemetics differed in the timing at which the drugs were administered. However, antiemetic drugs are not administered post-operatively until noxious stimuli caused by drugs used during anesthesia and operative procedures. The purpose of this study was 1) to determine whether preoperative scheduled administration of an antiemetic drug can reduce iatrogenic postoperative nausea and vomiting (PONV) in TKA compared to postoperative administration, and 2) to determine whether there was a difference in postoperative pain, patient satisfaction, and complications after TKA between pre- and postoperative administrations.Methods This retrospective study included patients who were assigned to either intravenous administration of the antiemetic drug (ramosetron) 1 hour before surgery (pre-injection group: 50 patients) or at the end of surgery (post-injection group: 51 patients). The incidence of PONV and the frequency of rescue medicine use were recorded until 48 hours postoperation. Postoperative pain level and satisfaction were also assessed using the visual analogue scale (VAS). Possible complications associated with serotonin receptor antagonists; for example, headaches, dizziness, and drowsiness were also assessed.Results The incidence of nausea events was lower in the pre-injection group than in the post-injection group. However, there was no difference between the two groups in terms of frequency of vomiting events and the use of rescue medicine for PONV. Also, postoperative pain, satisfaction scores, and incidence of complications were not different between the two groups.Conclusions The patients with preoperative scheduled administration of antiemetics showed lower incidence of nausea events than those with postoperative administration. However, it is difficult to conclude that the extent of the effect was clinically significant. Further research is needed to determine the optimal timing and method for more effective antiemetic treatment.

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&ndash, 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 &plusmn, 0.8 and 3.3 &plusmn, 0.7 vs. 2.4 &plusmn, 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.