5-HT3 receptor antagonists for preventing postoperative nausea and vomiting after gynecological surgery: A systematic review and network meta-analysis.

Background: Gynecological surgery is generally associated with a high risk of postoperative nausea and vomiting (PONV), for which a combination of antiemetic therapies is advised, but adherence to these protocols is often low. Given the current reality, a preferred 5-HT₃ receptor antagonist for preventing PONV as a result of gynecological operations might be desirable. However, the efficiency of different 5-HT₃ receptor antagonists in gynecological operations was not clear.

Objective: To assess the effectiveness of different 5-HT₃ antagonists in preventing PONV after gynecological surgery.

Search strategy: Electronic databases, including PubMed, Embase, the Cochrane Library, and Web of Science, were searched for randomized clinical trials (RCTs) from their inception up to September 20, 2023.

Selection criteria: Patients who received only 5-HT₃ antagonists to prevent nausea and vomiting following gynecologic surgical procedures were included. Only RCT articles and English language literature were included.

Data collection and analysis: Two investigators independently assessed the study quality and performed data extraction. R software and STATA 17 were used for this network meta-analysis to compare treatments using a frequentist approach.

Main results: Palonosetron demonstrated superior efficacy compared with ondansetron, with a significant difference in "acute nausea," "overall nausea," "acute vomiting," "late vomiting," "late PONV," "overall PONV," "late rescue medicine" and ">24 h rescue medicine." There was a significant difference between palonosetron and ramosetron in "acute nausea," between ramosetron and ondansetron in ">24 h nausea," and between granisetron and ondansetron in "late vomiting." Additionally, granisetron and palonosetron are generally ranked higher in the P-score system.

Conclusions: In gynecological surgery, palonosetron demonstrated superior efficacy to ondansetron. Granisetron seemed to be the most effective alternative to palonosetron in our study.