Penehyclidine Hydrochloride: A Promising Antimuscarinic Agent for PONV Prophylaxis in Diverse Surgical Procedures.

Purpose: The purpose of this meta-analysis is to measure the effectiveness of penehyclidine hydrochloride hydrate (PHC)-an antimuscarinic drug-in preventing postoperative nausea and vomiting (PONV) for different surgeries.

Design: Meta-analysis.

Methods: According to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we conducted an online literature search using PubMed, Web of Science, Scopus, and Embase databases. Randomized control trials comparing PHC with placebo or any other standard treatments were included.

Findings: Our systematic review screened 54 articles, and four randomized control trials with 766 patients were included. There was no significant difference between PHC and the control group for the prevention of postoperative vomiting (risk ratio [RR] = 0.43). However, the subgroup analysis showed some promise. At 24 hours, PHC significantly decreased the incidence of postoperative nausea (RR = 0.31), postoperative vomiting (RR = 0.17), and PONV (RR = 0.33). While at 48 hours, PHC showed nonsignificant results for the same outcomes. PHC did not result in significantly higher rates of analgesia use, headache, dizziness, longer durations of stay in the postanesthesia care unit, or longer duration for extubation, but it showed significantly lower results for the use of antiemetics. Furthermore, PHC showed higher rates of dry mouth.

Conclusions: The findings suggest that PHC offers a promising option for PONV prophylaxis, particularly in surgical settings where early PONV are prevalent, with an acceptable safety profile. Further research is recommended to optimize dosing strategies and compare PHC with established antiemetics.