Abstract
Background & Objectives: Prophylactic anti-emetic for patients undergoing middle ear surgery is imperative. The current study investigated anti-nausea and anti-emetic efficacy of the combination of palonosetron and dexamethasone in the prevention of postoperative nausea, vomiting (PONV) compared with palonosetron alone after middle ear surgery. Materials & Methods: In this prospective double blind study, 90 ASA I or II adult patients scheduled for middle ear surgery under general anesthesia were randomly allocated to either group P (N=45) to receive 0.075 mg palonosetron only or group PD (N=45) to receive 0.075 mg palonosetron and 8 mg dexamethasone before induction of anesthesia. Patients were followed for episodes of PONV (nausea, retching, and vomiting) and rescue antiemetic requirements in 48 hrs after surgery. Postoperative pain and rescue analgesic requirements were assessed. Patients’ satisfaction at the end of the study period was also recorded. Results: The incidence of nausea was comparable between the two groups (6.7%, 11.1%, 8.8% and 15.5% in group P Vs 4.4%, 6.7%, 4.4% and 8.8% in group PD between 0-2 h, 0-6 h, 6-24 h and 0-24 h respectively). The incidence of vomiting was also comparable in both the groups (2.2%, 4.4%, 4.4% and 6.7% in group P Vs 0%, 6.7%, 2.2% and 2.2% in group PD between 0-2 h, 0-6 h, 6-24 h and 0-24 h respectively). No incidence of nausea or vomiting was observed in any patient of two groups between 24-48 h. No significant differences were seen in complete responders and rescue antiemetic requirements in group P and PD during study period. Significantly fewer patients required rescue analgesic for postoperative pain in group PD (11.1%) as compared to group P (31.1%) between 0-48 h (p=0.038). The patients were also found to be more satisfied in combination group. Conclusion: Addition of dexamethasone to palonosetron provided no demonstrable benefit in reducing incidence of PONV even though it significantly reduced the postoperative analgesic requirement and improved patient’s satisfaction.
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