A Comparative Study on the Efficacy of Intravenous Palonosetron Versus a Combination of Ondansetron and Dexamethasone as Prophylaxis for Prevention of Postoperative Nausea and Vomiting After Laparoscopic Surgeries

Deepak Krishnan; Arthi Asokan; Arunkumar Muthalu; Srinivasan Suganya; Chinthavali Sujatha

doi:10.7759/cureus.72214

A Comparative Study on the Efficacy of Intravenous Palonosetron Versus a Combination of Ondansetron and Dexamethasone as Prophylaxis for Prevention of Postoperative Nausea and Vomiting After Laparoscopic Surgeries

Cureus. 2024 Oct 23;16(10):e72214. doi: 10.7759/cureus.72214. eCollection 2024 Oct.

Authors

Deepak Krishnan¹, Arthi Asokan², Arunkumar Muthalu³, Srinivasan Suganya¹, Chinthavali Sujatha¹

Affiliations

¹ Department of Anaesthesiology and Critical Care, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry, IND.
² Department of Anaesthesiology and Critical Care, Sri Venkateshwaraa Medical College and Research Centre, Puducherry, IND.
³ Department of Critical Care, Mahatma Gandhi Medical College and Research Institute, Puducherry, IND.

Abstract

Background: The most troublesome complaint after general anaesthesia and surgery, especially laparoscopic surgeries, is postoperative nausea and vomiting (PONV). We routinely use pharmacologic prophylaxis to prevent PONV. In patients undergoing laparoscopic procedures, we assessed the effectiveness of palonosetron compared to ondansetron combined with dexamethasone in preventing the incidence of PONV.

Methods and materials: This was a prospective, randomised, double-blind study that included 60 patients aged 18 to 60 years of either sex belonging to ASA physical status I or II undergoing elective laparoscopic surgeries. Before induction of anaesthesia, patients were randomised into two equal groups to receive either 0.075mg of palonosetron (group 1) or 4mg of ondansetron with 4mg of dexamethasone (group 2). Any incidence of nausea or vomiting along with the severity was assessed using the visual analogue scale, and the need for the rescue antiemetic was noted. Statistical analysis was done using an independent sample T-test, chi-square test, and Fisher's exact test. P-value <0.05 was considered statistically significant.

Results: The overall incidence of PONV was 18% (11 patients), all of which were of mild to moderate severity. The palonosetron group had a lesser incidence of PONV, in three patients (10%) when compared to eight patients (26.6%) in the ondansetron and dexamethasone combination group over a period of 48 hours, but the difference was not statistically significant (P=0.854). The need for the rescue antiemetic was also comparable between both the groups (P=0.129), two patients required the rescue antiemetic (6.66%) in the palonosetron group, while in the ondansetron and dexamethasone group, six patients required the rescue antiemetic (20%).

Conclusion: Both palonosetron and ondansetron with dexamethasone prove to be comparably effective in preventing PONV in laparoscopic surgeries and achieving a complete response for a longer period, thus requiring fewer rescue medications with no adverse reaction.

Keywords: dexamethasone; laparoscopic surgeries; ondansetron; palonosetron; ponv.