Palonosetron versus ondansetron for prevention of postoperative nausea and vomiting during middle ear surgery: a double-blind, randomized, comparative trial

Abstract

Besides postoperative pain, postoperative nausea and/or vomiting (PONV) is the most frequent and most unpleasant adverse outcome of surgery and general anesthesia. It occurs in 20–30% of patients [1]. Moreover, from the patient’s point of view, the anesthetist is clearly responsible for this ‘big little problem’ during the early postoperative period [2].Although many scientifi c clinical studies have been conducted in recent years to overcome this problem, a global panacea for its total prevention has not been found.One of the approaches to manage PONV is the clinical use of serotonin (5- HT3) receptor antagonists, which represent a new antiemetic drug class with improved effi cacy, prolonged action, and reduced side eff ects. 5-HT3 receptors are located on the nerve terminals of the vagus in the periphery and centrally in the chemoreceptor trigger zone of the area postrema of the medulla oblongata [3].Ondansetron was the fi rst serotonin antagonist, and its introduction was a milestone in the prevention of nausea and vomiting. It was considerably more eff ective and had fewer side eff ects (no extrapyramidal symptoms or sedation) compared with other types of antiemetics [4].Palonosetron is a selective serotonin subtype-3 (5-HT3) receptor antagonist with a strong binding affi nity. It is used to prevent nausea and vomiting caused by cancer chemotherapy. In addition, it was granted FDA approval in March 2008 for the prevention of PONV during the period up to 24 h after surgery [5,6].Th e aim of this study was to assess the effi cacy and safety of palonosetron versus ondansetron for PONV during middle ear surgery (MES).