Prevention Of Postoperative Nausea And Vomiting In Patients Research Articles

Comparison of the effects of Aprepitant and Granisetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing Laparoscopic Cholecystectomy: A double-blind, randomized, controlled study

Background: Postoperative nausea and vomiting (PONV) is one of the most common findings in the first 24 hours after surgery, occurring in 30% of all patients and up to 80% of high-risk patients. We compared aprepitant (a neurokinin-1 receptor antagonist) and granisetron in preventing PONV in patients who underwent laparoscopic cholecystectomy (LC). Methods: Sixty-one patients (aged 18-90) and the American Society of Anesthesiologists (ASA) I-II class who underwent LC under general anesthesia were enrolled in the study. Our study aimed to compare the incidence of PONV between 0-6, 6-12, and 6-24 hours postoperatively and the need for additional antiemetic requirements primarily and, secondly, detecting VAS scores and additional analgesic requirements for aprepitant and granisetron. Results: Our study observed similar PONV changes in both groups at 0-6 hours. A significantly lower VDS was observed in group A at 30-60 minutes compared to group G (p=0.10). There was no significant difference between groups at other intervals until the 120th minute. Between 6 and 12 hours, Group A had a lower VDS (Verbal Descriptive Scale) than Group G, but there was no statistically significant difference (P>0.05). There was no significant difference between the groups regarding VAS scores, additional analgesic requirements, and adverse effects on patients (p>0.05). Conclusion: We observed that aprepitant may be more effective than granisetron in preventing PONV and can be used safely in patients undergoing LC.

Efficacy of Gabapentin versus Combination of Dexamethasone-Ondansetron in Prevention of Postoperative Nausea and Vomiting in Middle Ear Surgery: A Randomised Clinical Study

Introduction: Postoperative Nausea and Vomiting (PONV) is the most common and unpleasant complication with incidence of 30-80% after elective surgery. Dexamethasone and Ondansetron (DO) combination has superior efficacy and is recommended as an ideal choice for prevention of PONV in Middle Ear Surgery (MES). Oral Gabapentin, an anticonvulsant has been introduced as an antiemetic to fast-track bundles and enhanced recovery after surgery. Aim: To compare the efficacy of DO with gabapentin monotherapy in prevention of PONV in patients undergoing MES. Materials and Methods: This randomised, double-blind, parallel group clinical study was done at Department of Anaesthesiology, St John’s Medical College, Bengaluru, Karnataka, India from November 2018 to March 2020. Sixty-six of patients were randomised to Group DO (Intravenous Dexamethasone at start and Ondansetron at end of surgery, 100 μg/kg each) and Group G (Oral Gabapentin 300 mg one hour prior to surgery). Postoperatively, incidence and severity of PONV, duration of antiemesis and analgesia, total rescue antiemetics and analgesics, along with side-effects were assessed for 24 hour period. Descriptive statistics was summarised for continuous (mean and standard deviation) and categorical (number with percentages) variables. Inferential statistics were depicted using Fisher’s-exact and Student’s t-test. Results: The demographic profile was comparable between the two groups. Incidence of PONV was significantly lesser in Group DO compared to the Group G (12% versus 36%, p-value=0.0129). Duration of antiemesis was four hours in Group DO and two hours in Group G was statistically significant (p-value=0.021). Severity of PONV was significant (p-value=0.033 and 0.009, respectively) at four and six hours between the groups. Duration of analgesia (6.28±5.96 in Group DO versus 5.62±3.63 hours in Group G; p-value=0.252), rescue analgesics and side-effects were comparable between the two groups (p-value>0.05). Conclusion: In MES, DO combination reduced the incidence and severity of PONV and is better prophylactic antiemetic therapy than gabapentin alone.

A comparison of prophylactic antiemetic therapy with palonosetron and dexamethasone as single-agents or in combination in adult patients undergoing laparoscopic surgery: A randomized trial.

The incidence of postoperative nausea and vomiting (PONV) is quite high after laparoscopic surgeries. This study endeavors to compare the efficacy of the combination of palonosetron and dexamethasone with that of either drug alone in the prevention of PONV in patients undergoing laparoscopic surgeries. This randomized, parallel-group trial was done on ninety adults of American Society of Anesthesiologists Grade I and II patients aged 18-60 years undergoing laparoscopic surgeries under general anesthesia. The patients were randomly divided into three groups of thirty patients each. Group P (n = 30) received palonosetron 0.075 mg intravenously (iv), Group D (n = 30) received dexamethasone 8 mg iv and Group P + D (n = 30) received palonosetron 0.075 mg and dexamethasone 8 mg iv. The primary outcome was incidence of PONV in 24 h, and the secondary outcome was a number of rescue antiemetics required. To compare the proportions in the groups, unpaired t-test, Mann-Whitney U-test, Chi-square test, or Fisher's exact test was applied. We found that the overall incidence of PONV was 46.7% in Group P, 50% in Group D, and 43.3% in Group P + D during the first 24 h. Rescue antiemetic was required in 27% of the patients in Group P and Group D compared to 23% of the patients in Group P + D and twice in 3% of the patients in Group P, 7% of the patients in Group D, and none in Group P + D which were not significant. The combination therapy of palonosetron plus dexamethasone did not significantly reduce the incidence of PONV when compared with either drug alone.

Comparison of palonosetron and aprepitant for prevention of post operative nausea and vomiting in females undergoing laparoscopic hysterectomy under general anesthesia

Background: Postoperative nausea and vomiting (PONV) is the second most common complaint following pain after surgery. In this era of daycare and outpatient-based surgery, PONV is the cause of delayed recovery and discharge from hospital settings. This study was designed to compare Palonosetron and Aprepitant for the prevention of PONV in patients undergoing laparoscopic hysterectomy under general anesthesia. Methods: 70 patients were included in this randomized double-blind study. Each group was allocated to receive either 0.075 mg of intravenous Palonosetron or 40mg of oral Aprepitant for PONV prophylaxis. A standard regimen of general anesthesia was administered to both groups for surgery. The primary outcome was the PONV impact severity scale (PISS) score at 48 hours following surgery in both groups. Secondary outcomes were the incidence of clinically significant PONV in both groups and the requirement of rescue antiemetics. Results: Mean PISS score at 48 hours was significantly lower (0.91±0.13 vs 3.43±0.2) in the Palonosetron group than in the Aprepitant Group. Incidence of PONV (16/35 vs 33/35) was significantly lower with Palonosetron. Incidence of clinically significant PONV and requirement of rescue antiemetics was significantly lower (2/35 vs 13/35) in the Palonosetron group.

Antiemetic effect of intravenous palonosetron and ondansetron for the prevention of postoperative nausea and vomiting following laparoscopic surgeries under general anaesthesia, a randomised observational study

Post-operative nausea and vomiting(PONV) is one of the common complications in patients undergoing laparoscopic surgeries under general anaesthesia. This study compares efficacy of prophylactic palonosetron and ondansetron in the prevention of PONV. After obtaining the approval of institutional ethical committee, a prospective randomised study was conducted on 60 patients belonging to American Society of Anaesthesiologists Grade I and II, patients of either sex, aged between 18 to 60 years, fulfilling the inclusion criteria were divided into two groups receiving inj. ondansetron 8 milligrams i.v. or inj. palonosetron 75 micrograms i.v. Incidence of PONV and need of rescue antiemetic was recorded post operatively. Data were evaluated statistically using Graph Pad Prism computer software version 6.04.It was found that inj. palonosetron 75mcg i.v. was more efficient in the prevention of PONV and required lesser rescue antiemetic when compared inj. ondansetron 8mg i.v. At conclusion of the study it was found that the prophylactic usage of inj. palonosetron 75 mcg i.v. is more effective than inj. ondansetron 8mg i.v. in the prevention of PONV in patients undergoing laparoscopic surgery (p value < 0.05).

Efficacy of Intravenous Glucose for Preventing Postoperative Nausea and Vomiting after Abdominal Hysterectomy under General Anesthesia

Objective: This study aimed to evaluate the ability of intravenous glucose administration during the maintenance of anesthesia as an alternative method for diminishing the incidence of postoperative nausea and vomiting (PONV) in patients undergoing total abdominal hysterectomy (TAH).Material and Methods: This was a prospective, double-blind randomized placebo-controlled trial. One hundred and ten patients who were 18 - 65 years old, American Society of Anesthesiology (ASA) 1 or 2 and required general anesthesia for TAH, were divided randomly to receive 5% DNSS (Group D) or normal saline (Group N) as a maintenance fluid at a rate of 2 mL/kg/hr. The primary outcome was the incidence of PONV at the arrival time in post-anesthetic care unit (PACU). The secondary outcomes were severity of PONV, time to first dose of an antiemetic drug, amount of antiemetic dose, and length of stay in the hospital.Results: The incidence of PONV in group N was 5.5% and in group D was 10.4% (p-value = 0.360). There were no statistically significant differences regarding the VRS scores, time to the first dose of antiemetic drug, the amount of antiemetic drug, and length of hospital stay between the 2 groups.Conclusions: There was no significant difference in efficacy between intravenous glucose administration and placebo in the prevention of PONV in patients undergoing abdominal hysterectomy under general anesthesia.

A RANDOMIZED, DOUBLE-BLIND STUDY OF PALONOSETRON COMPARED WITH ONDANSETRON IN PREVENTING POSTOPERATIVE NAUSEA AND VOMITING AFTER MODIFIED RADICAL MASTECTOMY SURGERY.

BACKGROUND : Palonosetron is a new potent 5-hydroxytryptamine 3 antagonist. Although used for chemo induced emesis, data is lacking for PONV. The high incidence of nausea and vomiting after breast surgery is well documented. This study compared the effects of i.v.ondansetron and palonosetron administered at the time of induction for preventing postoperative nausea and vomiting (PONV) in these high-risk patients . The aim was to compare Onda METHODS : nsetron 8 mg and Palonosetron 0.075mg administered intravenously for prevention of post operative nausea and vomiting in patients undergoing modied radical mastectomy 24 hours postoperatively, by a randomised , controlled, double blind study. 70 female non smoking patients scheduled for elective modied radical mastectomy were, allocated randomly into 2 groups . Patients received either Palonosetron 0.075mg (GROUP P ) or ondansetron 8mg ( GROUP O ) intravenously, immediately before induction of general anaesthesia. The occurence of nausea, vomiting, retching, need for rescue antiemetics and side effects were monitored for a period of 24 hours after surgery. The compete response rate and overall PONV for 0 - 24 hours were calculated. The demographic prole of the patients were comparable. The RESULTS : incidence of a complete response (no PONV, no rescue antiemetics ) during 0 - 24 hours in post operative period was signicantly high in GROUP P ( 85.7% vs 62.9%, p=0.02) than GROUP O. The incidence of nausea was signicantly low in GROUP P ( 14.3% vs 37.1%). There was no statistically signicant difference between the 2 groups in vomiting, retching, side effects and need for rescue antiemetics. Thus overall PONV was low in GROUP P (14.3% vs 37.1% p = 0.02 statistically signicant.) We conclude that Palonosetron 0.075mg was more effective for preventing PONV in patients undergoing modied radical mastectomy surgery

Preoperative Fasting Abbreviation and its Effects on Postoperative Nausea and Vomiting Incidence in Gynecological Surgery Patients.

To investigate the effects of preoperative fasting abbreviation with a carbohydrate and protein-enriched solution, on postoperative nausea and vomiting (PONV) incidence in gynecological surgery patients, a population naturally at risk for such unpleasant episodes. The present prospective double-blind randomized study was performed at The Hospital Municipal e Maternidade Dr. Odelmo Leão Carneiro (HMMOLC, in the Portuguese acronym), in Uberlândia, state of Minas Gerais, Brazil, in partnership with the Gynecology Department of the Universidade Federal de São Paulo (UNIFESP), approved by the Human Research Ethics Committee of UNIFESP and the board of HMMOLC, and included in the Brazil Platform and in the Brazilian Clinical Trial Registry. After signing the consent form, 80 women, who were submitted to gynecological surgery in the period from January to June 2016, were randomized into 2 groups: control group (n = 42) and juice group (n = 38). They received, respectively, 200 mL of inert solution or liquid enriched with carbohydrate and protein 4 hours presurgery. The incidence, frequency and intensity of PONV were studied using the Visual Analogue Scale (VAS), with statistical analysis performed by the software IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp, Armonk, NY, USA). The incidence of nausea and vomiting was lower than in the literature, to this population, with 18.9% (14/74) for the control group and 10.8% (8/74) for the juice group, respectively, with no statistically significant difference between the groups. The incidence of nausea and vomiting was lower than in the literature, but it cannot be said that this is due to the abbreviation of fasting. It can provide greater comfort, with the possibility of PONV prevention in patients at risk for these episodes.

Comparison of Palonosetron and Dexamethasone with Ondansetron and Dexamethasone to Prevent Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Cholecystectomy.

Background:Laparoscopic cholecystectomy (LC) is associated with high risk of postoperative nausea and vomiting (PONV) if no prophylactic antiemetic is used.Aims:The study compared prophylactic palonosetron and dexamethasone with ondansetron and dexamethasone in patients undergoing LC.Setting and Design:This prospective, double-blinded, randomized, controlled study was conducted at a tertiary care center.Materials and Methods:The study was carried out in 86 patients who underwent LC. The patients were randomly assigned to following study groups: Group 1 who received palonosetron (0.75 mg) with dexamethasone (8 mg) and Group II who received ondansetron (4 mg) with dexamethasone (8 mg). Patients were observed for nausea with visual analog scale and vomiting episode during 48 h postoperative follow-up.Statistical Analysis Used:Data were analyzed as mean, standard deviation, percentage, and number. The following statistical tests were used: paired or unpaired t-test, Mann–Whitney test, Chi-square test, and repeated ANOVA test.Results:There was no statistically significant difference in heart rate, mean arterial pressure, and oxygen saturation from baseline. During 48 h follow-up, the incidence of nausea, vomiting, and PONV was higher in Group II, but the difference was not statistically significant. The total dose of rescue antiemetic was 2.14 ± 4.15 mg in Group I and 5.00 ± 8.62 mg in Group II patients (P = 0.058). Headache was present in three patients in Group I and two patients of Group II.Conclusion:The palonosetron with dexamethasone is comparable to ondansetron with dexamethasone in the prevention of PONV in patients undergoing LC.

Dexamethasone versus Ondansetron in Prevention of Postoperative Nausea and Vomiting After Laparoscopic Surgery

Background: postoperative nausea and vomiting (PONV) are a common distressing symptoms in patients undergoing laparoscopic surgery and can contribute to anxiety, dehydration, metabolic abnormality, wound disruption, delayed recovery and other issues. The incidence of PONV varies from 20 to 80 % of all surgeries, and it is an economic and social burden. Aim of the Work: was to assess whether dexamethasone is a cost-effective alternative to ondansetron in the prevention of PONV in patients undergoing laparoscopic surgery. Patients and Methods: A study was conducted at Ain Shams University Hospitals between November 2017 and April 2018, after obtaining approval of research ethical committee and patients’ informed consents. 80 Patients were included in the study and underwent elective laparoscopic surgery and received general anesthesia. Results: The study showed a statistically significant difference between groups regarding PO nausea and other postoperative complications. Conclusion: Dexamethasone 8 mg was as effective as ondansetron 4 mg. Dexamethasone provided a simple, safe, cheap, and effective postoperative nausea and emesis prevention method with the advantage of being cheaper decreasing the economic burden.

Comparison of Palonosetron with Granisetron for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Abdominal Surgery.

Background:In patients undergoing laparoscopic surgeries, postoperative nausea and vomiting (PONV) is a serious concern. With an incidence of 46%–72%, PONV hampers the postoperative recovery in spite of the availability of many antiemetic drugs. The purpose of this study was to prospectively evaluate the efficacy of palonosetron and granisetron for the prevention of PONV in patients undergoing laparoscopic abdominal surgery.Aims:The aim of this study was to evaluate and compare the efficacy of palonosetron and granisetron in preventing PONV and to compare the duration of action and side effects in patients undergoing laparoscopic abdominal surgery under general anesthesia.Settings and Design:Eighty patients who were comparable in all aspects were considered for this study. After their consent, they participated in this prospective, randomized, double-blinded, comparative study.Materials and Methods:In this observational study, 80 patients of either gender who were undergoing laparoscopic abdominal surgery under general anesthesia were enrolled in the study. Based on computer randomization, these patients were divided equally into two groups of 40 patients each in double-blinded manner. The treatments were given intravenously 5 min before induction of anesthesia. The episodes of PONV, severity of nausea/vomiting, and side effects were observed during the first 48 h after surgery.Statistical Tests:At the end of study, results were compiled and SPSS® statistical package version 18.0 (SPSS Inc., Chicago, IL, USA). Two independent samples t-test was used for quantitative data, and Chi-square or Fisher's exact test was used for qualitative data. P < 0.05 was considered significant.Results:The incidence of PONV during 0–2 h in the postoperative period was 15% with palonosetron and 27.5% with granisetron; the incidence during 2–24 h postoperatively was 20% with palonosetron and 30% with granisetron. Both palonosetron and granisetron had comparable effectiveness as antiemetic during the early postoperative periods (0–24 h). During 24–48 h, the incidence was 17.5% and 37.5%, respectively (P = 0.04). Safety profile was similar in both the groups (P = 0.6).Conclusion:There were no significant differences in the overall incidence of PONV and complete responders for palonosetron and granisetron group in the early recovery period. However, due to its prolonged duration of action, palonosetron was more effective than granisetron for long-term prevention of PONV after laparoscopic abdominal surgery.

Granisetron plus dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: A meta-analysis.

ObjectiveThis study was designed to compare the effectiveness of granisetron plus dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery.MethodsWe searched the literature in the Cochrane Library, PubMed, EMBASE, and CNKI.ResultsIn total, 11 randomized controlled trials were enrolled in this analysis. The meta-analysis showed that granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopy surgery. No significant differences in adverse reactions (dizziness and headache) were found in association with dexamethasone.ConclusionGranisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopic surgery, with no difference in adverse reactions between the two groups. Granisetron alone or granisetron plus dexamethasone can be used to prevent PONV in patients undergoing laparoscopic surgery.

A Comparative Evaluation of Ramosetron with Ondansetron for the Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Urological Procedures.

Background:Postoperative nausea and vomiting (PONV) is a common problem causing distress to patients in the postoperative period. Younger age, gynecological surgeries, laparoscopic surgeries, female gender, volatile anesthetics, increased duration of anesthesia, and postoperative opioid use are associated with increased incidence of PONV.Aim:The present study was conducted to study the efficacy of ramosetron and its comparison with ondansetron in the prevention of PONV in patients undergoing pyelolithotomy, pyeloplasty, and upper ureterolithotomy.Methods:One hundred patients with physical status American Society of Anesthesiologists I and II, aged 20–60 years were enrolled in the study. Patients were randomly distributed to receive either injection ramosetron 0.3 mg intravenously (IV) or injection ondansetron 6 mg IV just before extubation.Results:There was no significant difference between the groups in age, gender, weight, duration of anesthesia, and duration of surgery. In the patients, who received ramosetron, it was observed that incidence of the episodes of nausea and vomiting increased with time after surgery. Each patient had an episode of nausea and an episode of vomiting during the 6–12 h interval. Similarly, two patients had episodes of nausea and two patients had episodes of vomiting at 18–24 h. This necessitated the increased need for rescue antiemetics with a total of four patients needing rescue antiemetics at 18–24 h. In patients receiving ondansetron, the episodes of nausea were more in number when compared with the ramosetron group. Twelve patients complained of nausea and thirteen patients had episodes of vomiting with the needfor rescue antiemetic in 14 patients. Both genders had a comparable incidence of nausea and vomiting.Conclusion:A single dose of IV ramosetron (0.3 mg) is more effective when compared with a single dose IV ondansetron (6 mg) in the prevention of PONV. We observed that the benefit was more in the later stages of the postoperative period (12–24 h).

A Randomized Controlled Trial Comparing the Efficacy of P6 Acupuncture Plus Ondansetron versus Ondansetron or P6 Acupuncture in the Prevention of Nausea and Vomiting after Bupivacaine-Morphine Spinal Anesthesia

Objective: To compare P6 acupuncture plus ondansetron with either ondansetron or P6 acupuncture in the prevention of postoperative nausea and vomiting (PONV) in patients submitted to spinal anesthesia. Methods: A randomized controlled trial was performed with 90 patients undergoing orthopedic surgery under spinal anesthesia with bupivacaine, 15 to 17.5 mg, and morphine, 100 μg. They were assigned to one of the three groups: Group Ondansetron (n = 30), patients were given ondansetron, 8 mg intravenously, before spinal block was performed; Group P6 acupuncture (n = 30), patients were subjected to bilateral electrical stimulation of P6 acupoint for 30 minutes before anesthesia; and Group P6 acupuncture plus ondansetron (n = 30), the exact combination of the groups Ondansetron and P6 acupuncture. Results: In the post anesthesia care unit, the incidence of nausea and vomiting ranged from 13.3% to 26.7% and from 6.7% to 13.3%, respectively, with no significant differences among groups (p > 0.05). Ondansetron group had the highest incidence of nausea (73.3%) (p < 0.001) and vomiting (43.3%) (p < 0.001) at the ward from 0 to 24 hours, followed by P6 acupuncture (33.3% and 26.7%) and P6 acupuncture plus ondansetron groups (16.0% and 0%). Conclusion: Preoperative stimulation of P6 acupoint in combination with ondansetron has higher efficacy than either P6 acupoint stimulation or the administration of ondansetron on the prevention of PONV in patients submitted to bupivacaine-morphine spinal anesthesia.

Acupuncture and PC6 stimulation for the prevention of postoperative nausea and vomiting in patients undergoing elective laparoscopic resection of colorectal cancer: a study protocol for a three-arm randomised pilot trial

IntroductionThis study aims to assess the feasibility of acupuncture and a Pericardium 6 (PC6) wristband as an add-on intervention of antiemetic medication for the prevention of postoperative nausea and vomiting...

A comparison of palonosetron and dexamethasone for postoperative nausea and vomiting in orthopedic patients receiving patient-controlled epidural analgesia.

BackgroundPostoperative nausea and vomiting (PONV) is one of the major concerns after anesthesia and surgery, and it may be more frequent in orthopedic patients receiving patient-controlled epidural analgesia (PCEA). The purpose of this study was to compare the effect of palonosetron and dexamethasone on the prevention of PONV in patients undergoing total joint arthroplasty and receiving PCEA.MethodsPatients scheduled for total hip or knee arthroplasty under spinal anesthesia/PCEA were randomly allocated to receive either intravenous palonosetron (0.075 mg, n = 50) or dexamethasone (5 mg, n = 50). Treatments were administered intravenously to the patients 30 min before the beginning of surgery. The total incidence of PONV and incidence in each time period, severity of nausea, need for rescue anti-emetics, pain score, and adverse effects during the first 48 h postoperatively were evaluated.ResultsThe total incidence of PONV was lower in the palonosetron group compared with the dexamethasone group (18.4% vs. 36.7%, P = 0.042), but there were no statistically significant differences in incidence between the groups at all time points. No significant intergroup differences were observed in the severity of nausea, use of rescue anti-emetics, pain score, and adverse effects.ConclusionsAlthough there were no significant differences in the incidence of PONV between the treatment groups at all time points, intravenous palonosetron reduced the total incidence of PONV in orthopedic patients receiving PCEA compared with dexamethasone.

A randomized, double-blind trial evaluating the efficacy of palonosetron with total intravenous anesthesia using propofol and remifentanil for the prevention of postoperative nausea and vomiting after gynecologic surgery

Palonosetron has potent and long-acting antiemetic effects for postoperative nausea and vomiting (PONV). The aim of this study was to prospectively evaluate the efficacy of palonosetron when used with total intravenous anesthesia (TIVA) using propofol and remifentanil for the prevention of PONV in patients undergoing laparoscopic gynecologic surgery. This prospective double-blind study comprised 100 female American Society of Anesthesiologist physical status I and II patients who were undergoing laparoscopic gynecologic surgery under TIVA. The patients were randomly assigned to two groups-the palonosetron plus TIVA group (palonosetron 0.075mg i.v., n=50) and the TIVA group (normal saline 1.5ml i.v., n=50). The treatments were given before the induction of anesthesia. The incidence of PONV, severity, number of rescue antiemetics, adverse effects, and patient satisfaction during the first 24h after surgery were evaluated. The demographic profiles of the patients in the two groups were comparable. The overall incidence of PONV (0-24h) was significantly lower in the TIVA plus palonosetron group than in the TIVA group (34 vs 58%, p=0.027). In particular, during the 6-24h after surgery, the incidence of PONV (14 vs 30%, p=0.03) and the incidence of moderate to severe nausea (6 vs 22%, p=0.041) were significantly lower in the TIVA plus palonosetron group than in the TIVA group. There were no significant differences in adverse effects, use of rescue antiemetics or patient satisfaction. Combining palonosetron with TIVA can be considered as a good method to prevent PONV, not only during the short postoperative period but also especially during the 6-24-h period after anesthesia.

5HT3 Antagonists versus Dexamethasone in the Prevention of PONV in Patients Undergoing Laparoscopic Cholecystectomy: A Meta-Analysis of RCTs.

Background. 5HT3 antagonist, an antiemetic alternative to dexamethasone, is an effective drug for the prevention of postoperative nausea and vomiting (PONV). Methods. PubMed and The Cochrane Library (from inception to June 2016) were searched for relevant RCTs (randomized controlled trials). Results. Seven trials, totaling 682 patients, were included in this meta-analysis. This meta-analysis demonstrated that 5HT3 antagonist was as effective as dexamethasone in preventing PONV (RR, 1.12; 95% CI, [0.86, 1.45]; P = 0.40) within 24 hours of laparoscopic cholecystectomy, and no significant heterogeneity was observed among the studies (I 2 = 0%; P = 0.98). During the early postoperative period (0–6 h), 5HT3 antagonists were superior to dexamethasone in reducing POV (RR, 0.31; 95% CI, [0.11, 0.93]; P = 0.04), while, in other postoperative stages (6–12 h, 12–24 h, and 0–24 h), it was not more effective in the prevention of POV than dexamethasone. And no significant difference was found in the prevention of PON between 5HT3 antagonists and dexamethasone at different postoperative periods (0–6 h, 6–12 h, 12–24 h, and 0–24 h). Conclusions. As a result, it is advisable to encourage 5HT3 antagonists as an alternative to dexamethasone for the prevention of PONV in patients undergoing laparoscopic cholecystectomy.

Gabapentin Prophylaxis for Postoperative Nausea and Vomiting in Abdominal Surgeries

Introduction Postoperative nausea and vomiting (PONV) is frequently encountered in the surgical recovery room. Abdominal surgery is one important risk factor for increased incidence of PONV. Gabapentin, an anticonvulsant with known postoperative analgesic properties, has shown some activity against PONV. Results from clinical trials evaluating the anti-emetic efficacy of gabapentin are conflicting. The present meta-analysis was performed to examine this issue. Methods Seventeen randomized placebo-controlled trials reporting PONV with preoperative gabapentin administration in patients undergoing abdominal surgery were included for analysis. Outcomes evaluated were nausea, vomiting, composite PONV and the use of rescue anti-emetic medication in the postoperative period. Results The pooled relative risk (RR), estimated using the random effects model of the metafor package for R, was 0.76 (95% CI 0.58–0.98) for nausea, 0.62 (0.45–0.85) for vomiting, 0.71 (0.39–1.28) for data represented as composite PONV (possibly biased by a single study, as observed in the sensitivity analysis), and 0.6 (0.41–0.89) for rescue anti-emetic use. There was a significant RR reduction for nausea and vomiting when propofol was not used as induction and/or maintenance for anaesthesia. In the abdominal hysterectomy subgroup, there was a significant RR reduction for vomiting but not for nausea. Discussion The present analysis provides evidence supporting preoperative gabapentin as a pharmacotherapy for prevention of PONV in patients undergoing abdominal surgeries. Future studies comparing preoperative gabapentin with 5HT3 antagonists are needed to precisely define its role in PONV.

Dexamethasone versus ondansetron in the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: a meta-analysis of randomized controlled trials.

BackgroundDexamethasone is an antiemetic alternative to ondansetron. We aimed to compare the effects of dexamethasone and ondansetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery.MethodsWe searched PubMed, Embase, Medline and Cochrane Library (from inception to July 2014) for eligible studies. The primary outcome was the incidence of PONV during the first 24 h after surgery. The secondary outcomes included PONV in the early postoperative stage (0–6 h), PONV in the late postoperative stage (6–24 h), and the postoperative anti-emetics used at both stages. We calculated pooled risk ratios (RR) and 95 % CIs using random- and fixed-effects models.ResultsSeven trials involving 608 patients were included in this meta-analysis, which found that dexamethasone had a comparable effectiveness in preventing PONV (RR, 0.91; 95 % CI, 0.73-1.13; P = 0.39) with that of ondansetron within 24 h of laparoscopic surgery, with no evidence of heterogeneity among the studies (I2 = 0 %; P = 0.71). In the early postoperative stage (0–6 h), ondansetron was better at decreasing PONV than dexamethasone (RR, 1.71; 95 % CI, 1.05-2.77; P = 0.03), while in the late postoperative stage (6–24 h), dexamethasone was more effective in preventing PONV than ondansetron (RR, 0.51; 95 % CI, 0.27-0.93; P = 0.03). There was no significant difference in the postoperative anti-emetics used (RR, 0.90; 95 % CI, 0.67-1.19; P = 0.45).ConclusionsDexamethasone was as effective and as safe as ondansetron in preventing PONV. Dexamethasone should be encouraged as an alternative to ondansetron for preventing PONV in patients undergoing laparoscopic surgery.