Ondansetron versus palonosetron: a comparative study on efficacy and safety in prevention of postoperative nausea and vomiting

Authors

  • Bhanu Prakash G. SVIMS, Sri Padmavathi Medical College for Women, SVIMS University, Tirupati, Andhra Pradesh, India
  • Umamaheswara Rao K. SVIMS, Sri Padmavathi Medical College for Women, SVIMS University, Tirupati, Andhra Pradesh, India
  • Subash K. R. SVIMS, Sri Padmavathi Medical College for Women, SVIMS University, Tirupati, Andhra Pradesh, India
  • Vijaya Chandra Reddy K. SVIMS, Sri Padmavathi Medical College for Women, SVIMS University, Tirupati, Andhra Pradesh, India
  • Jyothi Prasad K. SVIMS, Sri Padmavathi Medical College for Women, SVIMS University, Tirupati, Andhra Pradesh, India
  • Vasundara Devi B. SVIMS, Sri Padmavathi Medical College for Women, SVIMS University, Tirupati, Andhra Pradesh, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20161869

Keywords:

Surgery, General anaesthesia, PONV, Ondansetron, Palonosetron

Abstract

Background: Postoperative nausea and vomiting (PONV) is a major complication in patients who undergo surgery under general anaesthesia. Various drug regimens and antiemetic interventions have been tried from time-to-time for prevention of PONV but with a variable success rate. This study compares the safety and efficacy of ondansetron and palonosetron in preventing PONV in such patients.

Methods: A prospective study was conducted in 60 ASA grades - I and II patients of either sex, aged between 20 to 50 years, scheduled for elective surgery under general anaesthesia, 30 of who received 4 mg ondansetron and the remaining 30 received 0.05 mg palonosetron intravenously 5 minutes before induction of anaesthesia. Postoperatively they were observed for 24 hours for complete response, any episodes of nausea and vomiting, their severity, need for rescue antiemetic and side effects. After the study, results were compiled and the data was analysed using Student’s T test. P value <0.05 was considered significant.

Results: PONV was 40% in ondansetron group and 17% in palonosetron group (p >0.5). Complete antiemetic response was 60% in ondansetron group and 83% in palonosetron group. There was no significant statistical difference between both the groups in causing headache (p >0.5) and dizziness (p >0.05).

Conclusions: Our study concludes that the antiemetic efficacy is comparable for both ondansetron and palonosetron in the given doses in preventing PONV and none is superior. Both the study drugs had almost the same adverse effect profile.

References

Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006;102:1884-98.

Cohen MM, Duncan PG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg. 1994;78:7-16.

Kovac AL. Prevention and treatment of postoperative nausea and vomiting. Drugs. 2000;59:213-43.

Raphael JM, Norton AC. Antiemetic efficacy of prophylactic ondansetron in laparoscopic surgery. Br J Anaesth. 1993;71:845-8.

Rojas C, Stathis M, Thomas AG, Massuda EB, Alt J, Zhang J et al. Palonosetron exhibits unique molecular interactions with the 5-HT3 receptor. Anesth Analg. 2008;107:469-78.

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;107:445-51.

Rojas C, Stathis M, Thomas AG, Massuda EB, Alt J, Zhang J et al. Palonosetron exhibits unique molecular interactions with the 5-HT3 receptor. Anesth Analg. 2008;107:469-78.

Sukhminderjit SB, Sukhwinder KB, Jasbir K, Veenita S, Amarjit S, Anita S, et al. Palonosetron: a novel approach to control postoperative nausea and vomiting in day care surgery. Saudi J Anaesth. 2011;5:19-24.

Moon YE, Joo J, Kim JE, Lee Y. Anti-emetic effect of ondansetron and palonosetron in thyroidectomy: a prospective, randomized, double-blind study. Br J Anaesth. 2012;108:417-22.

Schulman ST, Rocket CB, Canada AT, Glass PS. Long term propofol infusion for refractory post-operative nausea. Anesth Analg. 1995;80:636-7.

Wang PK, Tsay PJ, Huang CC, Lai HY, Lin PC, Huang SJ, Lee Y. Comparison of dexamethasone with ondansetron or haloperidol for prevention of patient-controlled analgesia-related postoperative nausea and vomiting: a randomized clinical trial. World J Surg. 2012;36(4):775-81.

Tramer MR, Reynolds DJ, Moore RA, McQuay HJ. Efficacy, dose-response and safety of ondansetron in prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized placebo-controlled trials. Anesthesiology. 1997;87(6):1277-89.

MGI Pharma 2008. ALOXI (Palonosetron HCl) prescribing information. Available at URL:http://www.aloxi.com/common/downloads/pi.pdf. Accessed on 3 August 2011.

Apfel CC, Stoecklein K, Lipfert P. PONV: a problem of inhalational anaesthesia? Best Pract Res Clin Anaesthesiol. 2005;19(3):485-500.

Muchatuta NA, Paech MJ. Management of postoperative nausea and vomiting: focus on palonosetron. Ther Clin Risk Manag. 2009;5:21-34.

Honkavaara P. Effect of ondansetron on nausea and vomiting after middle ear surgery during general anaesthesia. Br J Anaesth. 1996;76(2):316-8.

Kovac AL, Eberhart L, Kotarski J, Clerici G, Apfel C. A randomized, double-blind study to evaluate the efficacy and safety of three different doses of palonosetron versus placebo in preventing postoperative nausea and vomiting over a 72-hour period. Anesth Analg. 2008;107:439-44.

Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, Rauch S, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth. 2002;88(5):659-68.

Stadler M, Bardiau F, Seidel L, Albert A, Boogaerts JG. Difference in risk factors for postoperative nausea and vomiting. Anesthesiology. 2003;98(1):46-52.

Sinclair DR, Chung F, Mezei G. Can postoperative nausea and vomiting be predicted? Anesthesiology. 1999;91:109-118.

Tramer M, Moore A, Mcquay H. Omitting nitrous oxide in general anaesthesia: meta-analysis of intraoperative awareness and postoperative emesis in randomized controlled trials. Br J Anaesth. 1996;76(2):186-93.

Roberts GW, Bekker TB, Carlsen HH, Moffatt CH, Slattery PJ, McClure AF. Postoperative nausea and vomiting are strongly influenced by postoperative opioid use in a dose-related manner. Anesth Analg. 2005;101(5):1343-8.

Lerman J. Surgical and patient factors involved in postoperative nausea and vomiting. Br J Anaesth. 1992;69(1):24-32.

Nupur C, Shiv KR. Comparison between efficacy of palonosetron and ondansetron in postoperative nausea and vomiting in middle ear surgery: a randomized double blind study. Int J Pharm Bio Sci. 2013;4(4):67-74.

Pritchard JF. Ondansetron metabolism and pharmacokinetics. Semin Oncol. 1992;19(4-10):9-15.

Downloads

Published

2017-01-05

How to Cite

G., B. P., K., U. R., R., S. K., K., V. C. R., K., J. P., & B., V. D. (2017). Ondansetron versus palonosetron: a comparative study on efficacy and safety in prevention of postoperative nausea and vomiting. International Journal of Basic & Clinical Pharmacology, 5(4), 1269–1274. https://doi.org/10.18203/2319-2003.ijbcp20161869

Issue

Section

Original Research Articles