A Meta-Analysis of Efficacy and Safety of Penehyclidine for PostoperativeNausea and Vomiting

Introduction: Postoperative nausea and vomiting (PONV) remain among the most frequent and distressing complications following surgery, often hindering patient recovery and comfort. Penehyclidine, an anticholinergic agent, has been explored as a potential treatment for PONV, yet its safety and efficacy are still under investigation. This systematic review and metaanalysis aim to synthesize current evidence on the effectiveness and safety of penehyclidine in preventing and managing PONV. Methods: A comprehensive search was performed across several major databases, including PubMed, Scopus, Web of Science, and the Cochrane Library, to identify randomized controlled trials evaluating penehyclidine's efficacy in PONV management. Relevant data were extracted from eligible studies, and outcomes of interest were analyzed. A meta-analysis using a randomeffects model was conducted with RevMan software. Results: Meta-analysis revealed that penehyclidine significantly reduced the incidence of PONV at both 24 hours (RR = 0.61, 95% CI [0.48-0.82]; p = 0.001) and 48 hours postoperatively (RR = 0.69, 95% CI [0.55-0.86]; p = 0.0009). It also significantly lowered the requirement for rescue antiemetics (RR = 0.34, 95% CI [0.19-0.61]; p = 0.0003). Additionally, patients receiving penehyclidine experienced a greater likelihood of complete symptom relief (RR = 1.37, 95% CI [1.10-1.72]; p = 0.005) and a reduced incidence of severe PONV (RR = 0.36, 95% CI [0.22- 0.60]; p < 0.0001). However, there were no significant differences observed in postoperative analgesic use (RR = 0.99, 95% CI [0.71-1.36]; p = 0.93) or length of stay in the post-anesthesia care unit (PACU) (MD = 0.14 minutes, 95% CI [-0.95, 1.23]; p = 0.81). Notably, penehyclidine was associated with an increased risk of dry mouth (RR = 2.68, 95% CI [2.10-3.43]; p < 0.00001), although other adverse effects-including headache, dizziness, fever, and urinary retention- showed no significant differences between groups. Conclusion: Penehyclidine demonstrates significant benefits in reducing both the incidence and severity of PONV, along with minimizing the need for additional antiemetic therapy. Its antiemetic effect extends up to 48 hours postoperatively, although this benefit is tempered by a higher likelihood of dry mouth. Importantly, its use does not influence postoperative analgesic consumption or PACU stay duration, supporting its specific utility in PONV management with a manageable safety profile. .