5‐ HT ₃ 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‐HT 3 receptor antagonist for preventing PONV as a result of gynecological operations might be desirable. However, the efficiency of different 5‐HT 3 receptor antagonists in gynecological operations was not clear. Objective To assess the effectiveness of different 5‐HT 3 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‐HT 3 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.