Ramosetron, midazolam, and combination of ramosetron and midazolam for prevention of postoperative nausea and vomiting: A prospective, randomized, double-blind study

Objective To compare the efficacy of ramosetron, midazolam, and the combination of ramosetron and midazolam in the prevention of postoperative nausea and vomiting (PONV) in female patients undergoing thyroidectomy. Methods Patients were randomized to receive 0.3mg ramosetron (Group R), 75 mu g/kg midazolam (Group M) or 0.3mg ramosetron combined with 75 mu g/kg midazolam (Group RM) before the induction of anaesthesia. PONV, use of rescue antiemetics, pain severity and fentanyl consumption were assessed for 24h after thyroidectomy. Results A total of 100 patients were enrolled; 94 patients completed the study. The severity of nausea was statistically significantly reduced at 0-2h in Group RM compared with Groups R and M, and at 2-6h in Group RM compared with Group M. The incidence of retching and vomiting was significantly lower at 0-2h, 2-6h, 6-12h in Group RM than in Group M, and lower in Group R than Group M at 6-12h. The requirement for rescue antiemetics was significantly lower at 0-2h in group RM than in group M. Conclusion The combination therapy of ramosetron and midazolam provided superior antiemetic efficacy compared with midazolam single therapy, but did not show any significant additional benefits compared with ramosetron single therapy.