Title: Evaluation of Palonosetron versus Ondansetron in Preventing Postoperative Nausea and Vomiting

Authors: Kiran Kumar.S, Kishan Rao

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i7.52

Abstract

Postoperative nausea and vomiting (PONV) is a common and distressing complication of surgery under general anaesthesia. This randomized, double-blind study evaluated the relative efficacy of palonosetron and ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing gynaecological laparoscopic surgery. Patients received either palonosetron 0.075 mg (n = 50) or ondansetron 8 mg (n = 50), intravenously, immediately before induction of general anaesthesia. The incidence of a complete response during 0-3 hour in the postoperative period was 70% with ondansetron and 92% with palonosetron, the incidence during 3-12 hour postoperatively was 60% with ondansetron and 92% with palonosetron. During 12-24 hour, the incidence was 54% and 90% and 24-48 hour the incidence was 50% and 88% respectively. In conclusion, palonosetron 0.075 mg was more effective than ondansetron 8 mg in preventing PONV.

Keywords: Antiemetics, anaesthesia, nausea, palonosetron, ondansetron, post-operative and vomiting.

References

 

1.      Watcha MF, White PF: Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology 1992; 77: 162 – 184.

2.      Muchatuta NA, Paech MJ: Management of postoperative nausea and vomiting: focus on palonosetron. TherClin Risk Manag 2009; 5: 21 – 34.

3.      Gan TJ: Risk factors for postoperative nausea and vomiting. AnesthAnalg 2006; 102: 1884 – 1898.

4.      Apfel CC, Läärä E, Koivuranta M, et al: A simplified risk score for predicting postoperative nausea and vomiting: conclusions from crossvalidations between two centers. Anesthesiology 1999; 91: 693 – 700.

5.      Lee A, Gin T, Lau AS, Ng FF. A comparison of patients' and health care professionals' preferences for symptoms during immediate postoperative recovery and the management of postoperative nausea and vomiting. AnesthAnalg 2005;100:87-93

6.      Van den Bosch JE, Bonsel GJ, Moons KG, Kalkman CJ. Effect of postoperative experiences on willingness to pay to avoid postoperative pain, nausea, and vomiting. Anesthesiology 2006;104:1033-9.

7.      Paxton DL, Mckay CA, Mirakin KR. Prevention of nausea and vomiting after day case gynaecological laparoscopy. A comparison of ondansetron, droperidol, metoclopramide and placebo. Anaesthesia 1995;50:403-6.

8.      Loewen PS, Marra CA, Zed PJ. 5-HT3 receptor antagonists vs. traditional agents for the prophylaxis of postoperative nausea and vomiting. Can J Anaesth 2000;47:1008-18.

9.      Wong EH, Clark R, Leung E, Loury D, Bonhaus DW, Jakeman L, et al. In vitro the interaction of a potent and selective antagonist, with 5-HT3 receptors. Br J Pharmacol 1995;114:851-9.

10.  Wong EH, Clark R, Leung E, et al: The interaction of RS 25259-197, a potent and selective antagonist, with 5-HT3 receptors, in vitro. Br J Pharmacol 1995; 114: 851 – 859.

11.  Stoltz R, Cyong JC, Shah A, et al: Pharmacokinetic and safety evaluation of palonosetron, a 5-hydroxytryptamine-3 receptor antagonist, in U.S. and Japanese healthy subjects. J ClinPharmacol 2004; 44: 520 – 531.

12.  Kovac AL, Eberhart L, Kotarski J, et al: 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. AnesthAnalg 2008; 107: 439 – 444.

13.  Aapro MS, Grunberg SM, Manikhas GM, 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.

14.  Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth 2000;84:6-10.

15.  Gan TJ. Risk factors for postoperative nausea and vomiting. AnesthAnalg 2006;102:1884-98.

16.  Lerman J. Surgical and patient factors involved in postoperative nausea and vomiting. Br J Anaesth.1992;69:245–325. 

17.  Janknegt R, et al. Clinical efficacy of antiemetics following surgery. Anaesthesia. 1999;54:1059–68

18.  Gan TJ: Mechanisms underlying postoperative nausea and vomiting and neurotransmitter receptor antagonist-based pharmacotherapy. CNS Drugs 2007; 21: 813 – 833

19.  Paventi S, Santevecchi A, Ranieri R: Efficacy of a single-dose ondansetron for preventing postoperative nausea and vomiting after laparoscopic cholecystectomy with sevoflurane and remifentanil infusion anaesthesia. Eur Rev Med PharmacolSci 2001; 5: 59 – 63.

20.  Bunce KT, Tyers MB. The role of 5-HT in postoperative nausea and vomiting. Br J Anaesth.1992;69( 1):S60–S62.

21.  Watcha MF, White PF. Postoperative nausea and vomiting: its etiology, treatment and prevention. Anesthesiology. 1992;77:162–84. 

22.  Ho KY, Gan TJ. Pharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting. CurrOpinAnaesthesiol 2006;19:606-11.

23.  Rojas C, Stathis M, Thomas A, Massuda E, Alt J, Zhang J, Rubenstein E, Sebastianis S, Canloreggi S, Snyder SH, Slusher B. Palonosetron exhibits unique molecular interactions with the 5-HT 3 receptor .AnesthAnalg. 2008;107:469–78. 

24.  Gralla R, Lichinitser M, Vander Vegt S, Sleeboom H, Mezger J, Peschel C, Tonini G, Libianca R, Macciocchi A, Aapro M. Palonosetron improves prevention of chemotherapy induced nausea and vomiting following moderately emetogenic chemotherapy: results of a double-blind randomized phase 3 trial comparing single doses of palonosetron with ondansetron. Ann Oncol. 2003;14:1570,

25.  Stoltz R, Cyong JC, Shah A, Parisi S. Pharmacokinetic and safety evaluation of palonosetron, a 5-hydroxytryptamine-3 receptor antagonist, in US and Japanese healthy subjects. J ClinPharmacol 2004;44:520-31.  

26.  Kovac AL. Prophylaxis of postoperative nausea and vomiting: controversies in the use of serotonin 5-hydroxytryptamine subtype 3 receptor antagonists. J ClinAnesth 2006;18:304-18

27.  Park SK and  cho EJ. A Randomized, Double-blind Trial of Palonosetron Compared with Ondansetron in Preventing Postoperative Nausea and Vomiting after Gynaecological Laparoscopic Surgery.  The Journal of International Medical Research 2011; 39: 399 – 407.

28.  Sukhminderjit Singh Bajwa, Sukhwinder Kaur Bajwa,  Jasbir Kaur, Veenita Sharma, Amarjit Singh, Anita Singh. Palonosetron: A novel approach to control postoperative nausea and vomiting in day care surgery Saudi journal of anaesthesia. 2011; 5(1): 19-24

29.  Ho KY, Gan TJ: Pharmacology, pharmacogenetics, and clinical efficacy of 5- hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting. CurrOpinAnaesthesiol 2006; 19: 606 – 611.

30.  Navari RM: Palonosetron: a second generation 5-hydroxytryptamine 3 receptor antagonist. Expert Opin Drug MetabToxicol 2009; 12: 1577 – 1586.

Corresponding Author

Kiran Kumar.S

Associate Professor, Dept of Anaesthesia,

Mamata Medical College, Khammam-507002 Telangana state, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile No.:8121719105