Details
Category: Volume 06 Issue 04 April 2018
Hits: 1371

Title: Comparison of intravenous ondansetron and palonosetron in prevention of postoperative nausea and vomiting in patients posted for elective laproscopic cholecystectomy

Authors: Dr Manoj Singhal, Dr Chiranji Lal Khedia, Dr Hansraj Charan

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.02

Abstract

Introduction: PONV is a major complication after anaesthesia, present in 20-30% range1. We compared efficacy and tolerance of ondansetron and palonosetron for PONV prohylaxis in patients posted for elective laproscopic cholecystectomy.

Method: 60 patients of age 20-60 years ,ASA I and II, scheduled for elective laproscopic cholecystectomy were randomized double blindly to receive either 8 mgbolus IV ondansetron and 16 mg was added to the PCA mixture (O group),or 0.075mg palonosetron only bolus dose (P group). Pregnancy, known hypersensitivity to both drugs, migraine, motion sickness were excluded. Chi squre test and Fisher exact test were used for statistic evaluation. Microsoft excel and epi info version 3.4.3 were used. P value <.05 considered significant. PONV (0 no nausea, 1 nausea,2 retching,3 vomiting), rescue antiemetics and side effects were assessed in 24 hr postoperative period.

Result: Both groups were comparable in demographic parameters (age, sex, weight). Overall incidence of PONV did not differ significantly (p=.57) but patients, who needed rescue antiemetics were significantly less in group P than group O (P=<.05). Additionally side effects were also less in group P.

Conclusion: In patients undergoing elective laproscopic chlecystectomy, use of palonosetron significantly reduced need of rescue antiemetics. Incidence of PONV and side effects were also less with P group.

Keywords: PONV, palonosetron, ondansetron.

References

  1. pfel CC, post operative nausea and vomiting, 7th edition, Churchill-livingstone elesvier publications. Miller’s anaesthesia, pp 2729-51.
  2. Gan TJ, Meyer T, Apfel CC, Chung F, Davis PJ, Eubanks S, et al. Consensus guidelines for managing postoperative nausea and vomiting. Anesth Analg. 2003; 97:62–71. [PubMed]
  3. Eisenberg P, MacKintosh FR, Ritch P, Cornett PA, Macciocchi A. Efficacy, safety and pharmacokinetics of palonosetron in patients receiving highly emetogenic cisplatin-based chemotherapy: a dose-ranging clinical study. Ann Oncol. 2004;15:330–337. [PubMed]
  4. Aapro MS, Grunberg SM, Manikhas GM, Olivares G, Suarez T, Tjulandin SA, et al. A phase III, double-blind, randomized trial of palonosetron compared with ondansetron in preventing chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy. Ann Oncol. 2006;17:1441–1449.[PubMed]
  5. Kovac AL, Eberhart L, Kotarski J, Clerici G, Apfel C. A randomized, double-blind study to evaluate the efficacy and safety of three different doses of palonosetron versus placebo in preventing postoperative nausea and vomiting over a 72-hour period. Anesth Analg. 2008;107:439–444. [PubMed]
  6. Candiotti KA, Kovac AL, Melson TI, Clerici G, Joo Gan T. A randomized, double-blind study to evaluate the efficacy and safety of three different doses of palonosetron versus placebo for preventing postoperative nausea and vomiting. Anesth Analg. 2008;107:445–451. [PubMed]
  7. 7. Yang LP, Scott LJ. Palonosetron: in the prevention of nausea and vomiting. Drugs. 2009;69:2257–2278.[PubMed]
  8. Stoltz R, Cyong JC, Shah A, Parisi S. Pharmacokinetic and safety evaluation of palonosetron, a 5-hydroxytryptamine-3 receptor antagonist, in U.S. and Japanese healthy subjects. J Clin Pharmacol. 2004;44:520–531. [PubMed]
  9. White LA, Vanarase M, Brockbank K, Barrett RF. Patient-controlled analgesia and postoperative nausea and vomiting: efficacy of a continuous infusion of ondansetron. Anaesthesia. 2001;56:365–369. [PubMed]
  10. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999;91:693–700. [PubMed]
  11. Kovac AL. Prevention and treatment of postoperative nausea and vomiting. Drugs. 2000;59:213–243.[PubMed]
  12. Lerman J. Surgical and patient factors involved in postoperative nausea and vomiting. Br J Anaesth. 1992;69(7 Suppl 1):24S–32S. [PubMed]
  13. Walder B, Schafer M, Henzi I, Tramer MR. Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain. A quantitative systematic review. Acta Anaesthesiol Scand. 2001;45:795–804.[PubMed]
  14. Tramer MR, Walder B. Efficacy and adverse effects of prophylactic antiemetics during patient-controlled analgesia therapy a quantitative systematic review. Anesth Analg. 1999;88:1354–1361.[PubMed]
  15. Bunce KT, Tyers MB. The role of 5-HT in postoperative nausea and vomiting. Br J Anaesth. 1992;69(7 Suppl 1):60S–62S. [PubMed]
  16. Rojas C, Stathis M, Thomas AG, Massuda EB, Alt J, Zhang J, et al. Palonosetron exhibits unique molecular interactions with the 5-HT3 receptor. Anesth Analg. 2008;107:469–478. [PubMed]
  17. Rojas C, Li Y, Zhang J, Stathis M, Alt J, Thomas AG, et al. The antiemetic 5-HT3 receptor antagonist palonosetron inhibits substance P-mediated responses in vitro and in vivo. J Pharmacol Exp Ther. 2010;335:362–368. [PMC free article] [PubMed]
  18. Habib AS, Gan TJ. Evidence-based management of postoperative nausea and vomiting: a review. Can J Anaesth. 2004;51:326–341. [PubMed]
  19. Tramer MR, Reynolds DJ, Moore RA, McQuay HJ. Efficacy, dose-response, and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials. Anesthesiology. 1997;87:1277–1289. [PubMed]
  20. Choi DK, Chin JH, Lee EH, Lim OB, Chung CH, Ro YJ, et al. Prophylactic control of post-operative nausea and vomiting using ondansetron and ramosetron after cardiac surgery. Acta Anaesthesiol Scand. 2010;54:962–969. [PubMed]
  21. Lim SM, Kim JY, Kang H, Baek CW, Park JW, Jung YH, et al. The effects of continuous infusion of ondansetron on postoperative nausea and vomiting in patients receiving IV-patient controlled analgesia following gynecological surgery Korean J Anesthesiol.  2008;55:176–181.
  22. Park SK, Cho EJ. A randomized, double-blind trial of palonosetron compared with ondansetron in preventing postoperative nausea and vomiting after gynaecological laparoscopic surgery. J Int Med Res. 2011;39:399–407. [PubMed]
  23. Moon YE, Joo J, Kim JE, Lee Y. Anti-emetic effect of ondansetron and palonosetron in thyroidectomy: a prospective, randomized, double-blind study. Br J Anaesth. 2012;108:417–422. [PubMed]
  24. Bhattacharjee DP, Dawn S, Nayak S, Roy PR, Acharya A, Dey R. A comparative study between palonosetron and granisetron to prevent postoperative nausea and vomiting after laparoscopic cholecystectomy. J Anaesthesiol Clin Pharmacol. 2010;26:480–483. [PMC free article] [PubMed]

Corresponding Author

Dr Chiranji Lal Khedia

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.