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 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, I-2 = 15.3%], [0-6 h, RR = 0.76 (95% CI: 0.44, 1.29), P = 0.137, I-2 = 45.7%], [12-24 h, RR = 0.39 (95%CI: 0.16, 0.96), P = 0.088, I-2 = 54.2%], [24-48 h, RR = 0.44 (95% CI: 0.20, 0.96), P = 0.598, I-2 = 0%], [24-72 h, RR 0.22 (95% CI: 0.08, 0.57), P = 0.119, I-2 = 53.0%] and vomiting [0-2 h, RR = 0.59 (95% CI: 0.29, 1.23), P = 0.868, I-2 = 0%], [0-6 h, RR = 1.42 (95% CI: 0.74, 2.72), P = 0.790, I-2 = 0%], [12-24 h, RR = 0.14 (95% CI: 0.04, 0.51), P = 0.749, I-2 = 0.0%], [24-48 h, RR = 0.24 (95%CI: 0.09, 0.62), P = 0.561, I-2 = 0%], [24-72 h, RR = 0.11 (95% CI: 0.02, 0.58), P = 0.859, I-2 = 0%]. The safety profiles of palonosetron and ondansetron were comparable [headache: RR = 0.82 (95%CI: 0.65, 1.04), P = 0.940, I-2 = 0%], [drowsiness: RR = 0.96 (95%CI: 0.54, 1.71), P = 0.870, I-2 = 0%], [constipation: RR=1.20 (95%CI: 0.52, 2.79), P = 0.650, I-2 = 0%], [dizziness: RR = 0.60 (95%CI: 0.44, 0.83), P = 0.644, I-2 = 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.