Comparative Evaluation of Ondansetron and Palonosetron for Postoperative Nausea and Vomiting In Abdominal Laparoscopic Surgeries: A Prospective Observational Comparative Study

Author(s): Krishika Verma, D K Sharma, Mukesh Gupta, Anant Gupta

Background and Aims: The incidence of PONV remains high despite recent advances in practice of anaesthesia and in management of PONV. Having a multifactorial etiology, multiple neurotransmitters involved in PONV includes serotonin, dopamine, acetylcholine, histamine, opioids and neurokinin-1. The present study is designed to evaluate the efficacy of palonosetron compared with ondansetron for preventing PONV in patient undergoing elective abdominal laparoscopic surgeries. Materials and methods: A prospective observational study was conducted in which eighty patients receiving general anaesthesia for laproscopic abdominal surgery were randomised into group O (n = 40) and group P (n = 40). In Group O all patients receive 4 mg of ondansetron intravenously and in Group P all patients receive palonosetron 0.075 mg intravenously prior to induction. In the post anesthesia care unit, the occurrence of nausea, vomiting, severity of nausea is assessed with the help of verbal descriptive scale (VDS). Rescue antiemetic drug is monitored at the end of the surgery at 0-2 hours, 2-6 hours. and 6-24 hours. Inj. Ondansetron 4 mg iv. is used as a rescue antiemetic. Details of any adverse effects is recorded. Results: In 2-6hrs post procedure, incidence of retching and vomiting between the 2 groups were comparable with insignificant p value but the incidence of nausea and requirement of rescue antiemetic came to be statistically significant. In 6-24hr post procedure,3 patients (7.5%) in group P suffered from vomiting whereas group O showed a higher incidence of vomiting i.e.30%.5 patients in group P suffered from nausea whereas 20 patients in group O suffered from nausea with p value of .001 which was statistically significant. During this period only 2 patients (5%) required rescue antiemetic in group P while 8 patients (20%) in group O required rescue antiemetic making the difference statistically significant. The severity of PONV measured in terms of VDS score was higher in group O as compared to group P patients in 2-6hrs (p=0.05) and 6-24hrs (p=0.001) postoperative period. Conclusion: Palonosetron is more efficacious in preventing PONV than ondansetron in patients undergoing elective abdominal laparoscopic surgeries.