Comparison of efficacy of palonosetron-dexamethasone combination with palonosetron or dexamethasone alone for prophylaxis against post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy

Abstract

Background and Aims:Post-operative nausea and vomiting (PONV) is highly distressing and unpleasant symptom. Dexamethasone and palonosetron are effective antiemetics with minimal side effect profile. This study compares the efficacy of palonosetron or dexamethasone alone and their combination (palonosetron plus dexamethasone) for prevention of PONV after laparoscopic cholecystectomy.Methods:This prospective, randomised, double-blind trial was done on 187 adults, American Society of Anesthesiologists Grade I and II patients, aged 18–75 years undergoing laparoscopic cholecystectomy. They were allocated to three groups which were to receive either of the three treatment regimens: dexamethasone 8 mg (Group D, n = 57), palonosetron 0.075 mg (Group P, n = 66) or dexamethasone 8 mg plus palonosetron 0.075 mg (Group PD, n = 64). The primary outcome was incidence of PONV in 24 h and the secondary outcome was a number of rescue antiemetic required. One-way ANOVA test was used to compare the means amongst three groups. To compare the proportions in the groups, Chi-square test/Fisher's exact test/Two proportions Z-test was applied as appropriate.Results:Overall incidences of PONV in the study 24 h postoperatively were 23.4% in PD, 27.2% in P group and 56.14% in D group (P < 0.001). Requirement of rescue antiemetic was more in dexamethasone group than other two groups (PD = 1 time, P = 1.38 times and D = 1.5 times).Conclusion:Palonosetron alone and palonosetron-dexamethasone combination were equally effective in the prevention of PONV. Dexamethasone alone was least effective amongst the three groups. There is no difference between palonosetron and palonosetron-dexamethasone for PONV prevention.

A prospective, randomized, double-blind trial to compare body weight-adjusted and fixed doses of palonosetron for preventing postoperative nausea and vomiting in obese female patients

“…The total incidence of PONV in our study was 21.25%, which is consistent with the results of other studies in the literature [3,5,[16][17][18]. During the first postoperative 24 h, the incidence of PONV was also comparable to other study results [17,19]. After 24 h, the incidence of PONV was lower in the GI group (5%) than in the GII group (12.5%), although the difference was not statistically significant (P = 0.43).…”

A comparison of prophylactic antiemetic therapy with palonosetron and dexamethasone as single-agents or in combination in adult patients undergoing laparoscopic surgery: A randomized trial

“…It was reported that palonosetron alone and a combination of palonosetron–dexamethasone were equally effective in the prevention of PONV; however, dexamethasone alone was least effective among the three groups. [ 19 20 ] The combination of palonosetron–dexamethasone was more effective as compared to only palonosetron for reducing PONV after laparoscopic cholecystectomy. [ 21 ] However, in our study, we observed that the combination of palonosetron–dexamethasone did not significantly reduce the incidence of PONV when compared with either drug alone.…”

Retrospective analysis of risk factors of postoperative nausea and vomiting in patients undergoing ambulatory strabismus surgery via general anaesthesia

“…Many prophylactic antiemetic agents have been recommended to minimise this postoperative side effect, a combination of dexamethasone and 5-HT 3 receptor antagonist has been suggested to prevent PONV in patients with a high risk. [ 4 ] The previous studies revealed that a combination of dexamethasone and ondansetron is more effective than ondansetron alone in reducing PONV after strabismus surgery,[ 13 14 ] our current regimen in preventing PONV includes a multimodality approach by using a combination of dexamethasone and 5-HT 3 receptor antagonist during anaesthesia induction. We found that the incidence of PONV following strabismus surgery with the combination of dexamethasone and 5-HT 3 receptor antagonist is significantly lower than that reported in previous studies,[ 12 ] this can be explained by the anaesthetic agents selected and non-use of N 2 O in our study.…”