A COMPARATIVE STUDY OF PALONOSETRON AND PALONOSETRON WITH DEXAMETHASONE FOR PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING IN PATIENTS UNDERGOING CAESAREAN SECTION: A DOUBLE BLINDED, RANDOMIZED CONTROL STUDY.
Abstract
Background: Post-operative nausea and vomiting (PONV) is one of the most common complication and patients’ complaints after surgery. Palonosetron, a newer generation of 5- HT antagonist has superior effects in prevention of PONV because of its unique action, longer duration of action and fewer side effects. Our study hypothesised that combination of dexamethasone with palonosetron would be more effective in prevention of PONV than palonosetron alone in pregnant patients undergoing caesarean section
Aim: To compare the effects of palonosetron versus palonosetron combined with dexamethasone in the prevention of PONV following caesarean section.
Methods: 120 patients of ASA II posted for LSCS were enrolled in our study. The patients were grouped randomly into 60 each viz: Group Palonosetron (P) receiving 0.075mg palonosetron and Group palonosetron+dexamethasone (PD) receiving 0.075mg palonosetron and 8mg dexamethasone. The frequency of PONV, complete response, side effects were compared between the groups.
Results: Patients experiencing episodes of PONV in Group P was found to be 15 (9%) as compared to 8 (4.8%) in Group PD. Complete response between group P and Group PD is 90% versus 96.3% respectively. Both these results when compared were not statistically significant. The occurrence of side effects were comparable between the two groups.
Conclusion: There was no significant difference between palonosetron and combination of palonosetron and dexamethasone in prevention of PONV.
Keywords
Full Text:
PDFReferences
Kapur PA. The big little problem. AnaesthAnalg 1991; 73:243-45.
McCracken G, Houston P, Lefebvre G Society of Obstetricians and Gynecologists of Canada. Guideline for the management of postoperative nausea and vomiting. J Obstet Gynaecol Can 2008;30:600–07.
Eberhart L, Morin AM, Wulf H, Geldner G. Patient preferences for immediate postoperative recovery. Br J Anaesth 2002;89:760–61.
Bayter M, Peña P, Marquez M, Cárdenas-Camarena L, Macias A, Rubio J, et al. Incidence of postoperative nausea and vomiting when total intravenous anaesthesia is the primary anaesthetic in the ambulatory patient population. Ambul Surg 2018;24:8-11.
Gan TJ. Postoperative nausea and vomiting-can it be eliminated? JAMA. 2002; 287: 1233-6.
Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006 Jun;102(6):1884-98.
Apfel CC, Läärä E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: Conclusions from cross-validations between two centers. Anesthesiology 1999;91:693-700.
Balki M, Carvalho JC. Intraoperative nausea and vomiting during cesarean section under regional anesthesia. Int J Obstet Anesth 2005 Jul;14(3):230-41.
Whatcha MF, White PF. Postoperative nausea and vomiting: its etiology, treatment and prevention [review]. Anaesthesiology 1992;77:162-84.
Gold BS, Kitz DS, Lecky JH, Neuhaus JM Unanticipated admission to the hospital following ambulatory surgery. Journal of the American Medical Association 1989; 262:3008-10.
Carroll NV, MiederhoffP, Cox FM, Hirsch JD. Post operative nausea and vomiting after discharge from outpatient surgery centers. Anesth Analg 1995; 80:903-9.
Horn CC, Wallisch WJ, Homanics GE, Williams JP. Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting. Eur J Pharmacol 2014; 722(1):55–66.
Stoicea N, Gan TJ, Joseph N, Uribe A, Pandya J, Dalal R, Bergese SD. Alternative Therapies for the Prevention of Postoperative Nausea and Vomiting. Front Med (Lausanne). 2015;2:87.
Imeh A, Olaniyi O, Simeon O, and Omotola O. Dexamethasone versus a combination of dexamethasone and ondansetron as prophylactic antiemetic in patients receiving intrathecal morphine for caesarean section. Afr Health Sci. 2014 Jun; 14(2): 453–9.
Swaro S, Karan D, Banerjee A. Comparison of palonosetron, dexamethasone, and palonosetron plus dexamethasone as prophylactic antiemetic and antipruritic drug in patients receiving intrathecal morphine for lower segment caesarean section. Anesth Essays Res 2018;12:322-7.
Candiotti KA, Kovac AL, Melson TI, Clerici G, Joo Gan T. A randomized, double-blind study to evaluate the efficacy and safety of three different doses of palonosetron versus placebo for preventing postoperative nausea and vomiting. Anesth Analg 2008 Aug;107(2):445-51.
Jadon A, Sinha N, Agrawal A, Jain P. Effect of intravenous dexamethasone on postoperative nausea-vomiting (PONV) after intrathecal morphine during caesarean Section. SOJ Anesthesiol Pain Manag 2016; 3(1):1-5.
Bisgaard T, Klarskov B, Kehlet H, Rosenberg J. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy-a randomized double blind placebo controlled trial. Ann Surg 2003; 238:651–60.
Backes JR, Jared C. Bentley JC, Joel R. Politi JR, Bryan T. Chambers BT. Dexamethasone Reduces Length of Hospitalization and Improves Postoperative Pain and Nausea After Total Joint Arthroplasty A Prospective, Randomized Controlled Trial Jeffrey R. J Arthroplasty 2013 Sep; 28(8):11-7
Allen TK, Jones CA, Habib AS. Dexamethasone for the prophylaxis of postoperative nausea and vomiting associated with neuraxial morphine administration: a systematic review and meta-analysis. Anesth Analg 2012 Apr;114(4):813-22.
Song JW, Park EY, Lee JG, Park YS, Kang BC, Shim YH. The effect of combining dexamethasone with ondansetron for nausea and vomiting associated with fentanyl-based intravenous patient-controlled analgesia. Anaesthesia 2011 Apr; 66(4): 263-7
Demirhan A, Tekelioglu YU, Akkaya A, Ozlu T, Yildiz I, Bayir H, et al. Antiemetic effects of dexamethasone and ondansetron combination during cesarean sections under spinal anaesthesia. Afr Health Sci 2013;13:475-82.
Szarvas S, Chellapuri RS, Harmon DC, Owens J, Murphy D, Shorten GD. A comparison of dexamethasone, ondansetron, and dexamethasone plus ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery. Anesth Analg 2003;97:259–63.
Ghosh S, Pal A, Acharya A, Biswas C, Ghosh TR and Ghosh S. Palonosetron and palonosetron plus dexamethasone to prevent postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: A prospective, randomized, double-blind comparative study. Anesth Essays Res 2011 Jul-Dec; 5(2):134–7.
Park JW, Jun JW, Lim YH, Lee SS, Yoo BH, Kim KM, Yon JH, and Hong KH. The comparative study to evaluate the effect of palonosetron monotherapy versus palonosetron with dexamethasone combination therapy for prevention of postoperative nausea and vomiting. Korean J Anesthesiol. 2012 Oct; 63(4):334-9.
Srivastava A, Raghavendra K P, Parate LH. A comparative study of palonosetron versus palonosetron and dexamethasone for the prevention of postoperative nausea and vomiting in subjects undergoing laparoscopic surgeries: A randomized double-blind control study. Karnataka Anaesth J 2016;2:19-24
Dahl JB, Jeppesen IS, Jørgensen H, Wetterslev J, Møiniche S. Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: A qualitative and quantitative systematic review of randomized controlled trials. Anesthesiology 1999;91:1919‑27.
Refbacks
- There are currently no refbacks.