Background: Craniotomy patients have a high incidence of postoperative nausea and vomiting (PONV). This\nprospective, randomized, double-blind, multi-center study was performed to evaluate the efficacy of prophylactic\nramosetron in preventing PONV compared with ondansetron after elective craniotomy in adult patients.\nMethods: A total of 160 American Society of Anesthesiologists physical status Iââ?¬â??II patients aged 19ââ?¬â??65 years who were\nscheduled to undergo elective craniotomy for various intracranial lesions were enrolled in this study. All patients\nreceived total intravenous anesthesia (TIVA) with propofol and remifentanil. Patients were randomly allocated into\nthree groups to receive ondansetron (4 mg; group A, n = 55), ondansetron (8 mg; group B, n = 54), or ramosetron\n(0.3 mg; group C, n = 51) intravenously at the time of dural closure. The incidence of PONV, the need for rescue\nantiemetics, pain score, patient-controlled analgesia (PCA) consumption, and adverse events were recorded 48 h\npostoperatively.\nResults: Among the initial 160 patients, 127 completed the study and were included in the final analysis. The incidences\nof PONV were lower (nausea, 14% vs. 59% and 41%, respectively; P < 0.001; vomiting, P = 0.048) and the\nincidence of complete response was higher (83% vs. 37% and 59%, respectively; P < 0.001) in group C than in\ngroups A and B at 48 h postoperatively. There were no significant differences in the incidence of PONV or need\nfor rescue antiemetics 0ââ?¬â??2 h postoperatively, but significant differences were observed in the incidence of PONV\nand complete response among the three groups 2ââ?¬â??48 h postoperatively. No statistically significant intergroup\ndifferences were observed in postoperative pain, PCA consumption, or adverse events.\nConclusion: Intravenous administration of ramosetron at 0.3 mg reduced the incidence of PONV and rescue\nantiemetic requirement in craniotomy patients. Ramosetron at 0.3 mg was more effective than ondansetron at 4\nor 8 mg for preventing PONV in adult craniotomy patients.
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