Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.08.001
Brazilian Journal of Anesthesiology
Clinical Research

Comparison of palonosetron-dexamethasone and ondansetron-dexamethasone for prevention of postoperative nausea and vomiting in middle ear surgery: a randomized clinical trial

Comparação entre palonosetrona-dexametasona e ondansetrona-dexametasona na prevenção de náuseas e vômitos no pós-operatório de cirurgia do ouvido médio: estudo clínico randomizado

Vinit Kumar Srivastava, Saima Khan, Sanjay Agrawal, Sweta Anil Deshmukh, Pooja Shree, Partha Pratim Misra

Downloads: 3
Views: 997

Abstract

Background
Postoperative nausea and vomiting is the second most common complaint in the postoperative period after pain. The incidence of postoperative nausea and vomiting was 60–80% in middle ear surgeries in the absence of antiemetic prophylaxis. Because of this high incidence of postoperative nausea and vomiting, we aimed to assess the effect of palonosetron-dexamethasone and ondansetron-dexamethasone combination for the prevention of postoperative nausea and vomiting in patients of middle ear surgery.

Methods
Sixty-four patients, scheduled for middle ear surgery, were randomized into two groups to receive the palonosetron-dexamethasone and ondansetron-dexamethasone combination intravenously before induction of anesthesia. Anesthesia technique was standardized in all patients. Postoperatively, the incidences and severity of nausea and vomiting, the requirement of rescue antiemetic, side effects and patient satisfaction score were recorded.

Results
Demographics were similar in the study groups. The incidence difference of nausea was statistically significant between groups O and P at a time interval of 2–6 hours only (p = 0.026). The incidence and severity of vomiting were not statistically significant between groups O and P during the whole study period. The overall incidence of postoperative nausea and vomiting (0–24 hours postoperatively) was 37.5% in group O and 9.4% in group P (p = 0.016). Absolute risk reduction with palonosetron–dexamethasone was 28%, the relative risk reduction was 75%, and the number-needed-to-treat was 4. The patient’s satisfaction score was higher in group P than group O (p = 0.016). The frequency of rescue medication was more common in group O than in group P patients (p = 0.026).

Conclusion
The combination of palonosetron-dexamethasone is superior to ondansetron-dexamethasone for the prevention of postoperative nausea and vomiting after middle ear surgeries.

Resumo

Justificativa
Náusea e vômito no pós-operatório é a segunda queixa pós-operatória mais frequente após a dor. Sem profilaxia antiemética, a incidência de náusea e vômito no pós-operatório foi de 60–80% após cirurgia do ouvido médio. Dada a alta incidência relatada de náusea e vômito no pós-operatório, nosso objetivo foi avaliar o efeito da combinação de palonosetrona-dexametasona e ondansetrona-dexametasona na prevenção de náusea e vômito no pós-operatório em pacientes submetidos a cirurgia do ouvido médio.

Método
Sessenta e quatro pacientes programados para cirurgia de ouvido médio foram aleatoriamente divididos em dois grupos. Um recebeu a combinação de palonosetrona-dexametasona (grupo P) e o outro ondansetrona-dexametasona (grupo O) por via intravenosa antes da indução anestésica. A técnica anestésica foi padronizada em todos os pacientes. No pós-operatório, foram registradas incidência e gravidade das náuseas e vômitos, necessidade de antiemético de resgate, efeitos colaterais e índice de satisfação dos pacientes.

Resultados
As características demográficas foram semelhantes nos grupos estudados. A diferença na incidência de náusea foi estatisticamente significante entre os grupos O e P apenas no intervalo de tempo entre 2 e 6 horas (p = 0,026). A incidência e gravidade de vômito não foram estatisticamente significantes entre os grupos O e P durante todo o período do estudo. A incidência geral de náusea e vômito no pós-operatório (0–24 horas de pós-operatório) foi de 37,5% no grupo O e de 9,4% no grupo P (p = 0,016). A combinação palonosetrona-dexametasona associou-se com redução do risco absoluto de 28%, redução do risco relativo de 75%, e o número necessário para tratar foi 4. O escore de satisfação do paciente foi maior no grupo P (p = 0,016). A frequência da medicação de resgate foi mais comum no grupo O (p = 0,026).

Conclusão
A combinação de palonosetrona-dexametasona é superior à ondansetrona-dexametasona na prevenção da náusea e vômito no pós-operatório após cirurgia de ouvido médio.

References

1 C. Moreno, D. Veiga, H. Pereira, et al. Postoperative nausea and vomiting: incidence, characteristics and risk factors – a prospective cohort study Rev Esp Anestesiol Reanim., 60 (2013), pp. 249-256

2 L.H. Eberhart, J. Högel, W. Seeling, et al. Evaluation of three risk scores to predict postoperative nausea and vomiting Acta Anaesthesiol Scand., 44 (2000), pp. 480-488

3 S. Larsson, D. Lundberg A prospective survey of postoperative nausea and vomiting with special regard to incidence and relations to patient characteristics, anesthetic routines and surgical procedures Acta Anaesthesiol Scand., 39 (1995), pp. 539-545

4 E.N. Aroke, T.L. Hicks Pharmacogenetics of Postoperative Nausea and Vomiting J Perianesth Nurs., 34 (2019), pp. 1088-1105

5 D.J. Reinhart, K.W. Klein, E. Schroff Transdermal scopolamine for the reduction of postoperative nausea in outpatient ear surgery: a double-blind, randomized study Anesth Analg., 79 (1994), pp. 281-284

6 P. Honkavaara, L. Saarnivaara, U.M. Klemola Prevention of nausea and vomiting with transdermal hyoscine in adults after middle ear surgery during general anaesthesia Br J Anaesth., 73 (1994), pp. 763-766

7 X. Cao, P.F. White, H. Ma An update on the management of postoperative nausea and vomiting J Anesth., 31 (2017), pp. 617-626

8 A.L. Kovac Comparative pharmacology and guide to the use of the serotonin 5HT3 receptor antagonists for postoperative nausea and vomiting Drugs, 76 (2016), pp. 1719-1735

9 A. Aydin, M. Kacmaz, A. Boyaci Comparison of ondansetron, tropisetron and palonosetron fot the prevention of postoperative nausea and vomiting after middle ear surgery Curr Ther Res Clin Exp., 91 (2019), pp. 17-21

10 P.M. Singh, A. Borle, D. Gouda, et al. Efficacy of palonosetron in postoperative nausea and vomiting (PONV) – a meta-analysis J Clin Anesth., 34 (2016), pp. 459-482

11 G.S. De Oliveira Jr, L.J. Castro-Alves, S. Ahmad, et al. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials Anesth Analg., 116 (2013), pp. 58-74

12 T.J. Gan, P. Diemunsch, A.S. Habib, et al. Consensus guidelines for the management of postoperative nausea and vomiting Anesth Analg., 118 (2014), pp. 85-113

13 I. Bala, N. Bharti, S. Murugesan, et al. Comparison of palonosetron with palonosetron-dexamethasone combination for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy Minerva Anestesiol., 80 (2014), pp. 779-784

14 S. Desai, M.C. Santosh, R. Annigeri, et al. Comparison of the antiemetic effect of ramosetron with the combination of dexamethasone and ondansetron in middle ear surgery: A double-blind, randomized clinical study Saudi J Anaesth., 7 (2013), pp. 254-258

15 Y. Fujii, H. Toyooka, H. Tanaka Prophylactic antiemetic therapy with a combination of granisetron and dexamethasone in patients undergoing middle ear surgery Br J Anaesth., 81 (1998), pp. 754-756

16 A. Chatterjee, S. Sahu, M. Paul, et al. Comparison of efficacy of palonosetron-dexamethasone combination with palonosetron or dexamethasone alone for prophylaxis against post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy Indian J Anaesth., 61 (2017), pp. 978-984

17 A.L. Kovac, L. Eberhart, J. Kotarski, et al. 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., 107 (2008), pp. 439-444

18 L. Sekhavat, R. Davar, S. Behdad Efficacy of prophylactic dexamethasone in prevention of postoperative nausea and vomiting J Epidemiol Glob Health., 5 (2015), pp. 175-179

19 S. Paventi, A. Santevecchi, R. Ranieri Efficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting after laparoscopic cholecystectomy with sevoflurane and remifentanil infusion anaesthesia Eur Rev Med Pharmacol Sci., 5 (2001), pp. 59-63

20 J.J. Wang, S.T. Ho, J.I. Tzeng, et al. The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting Anesth Analg., 91 (2000), pp. 136-139

21 S. Sharma, S. Khanna, J. Das, et al. A randomized study to compare palonosetron with ondansetron for prevention of postoperative nausea and vomiting following middle ear surgeries J Anaesthesiol Clin Pharmacol., 35 (2019), pp. 182-187

22 C.C. Apfel, E. Läärä, M. Koivuranta, et al. A simplified Risk score for predicting postoperative nausea and vomiting: Conclusions from cross-validations between two centers Anesthesiology., 91 (1999), pp. 693-700
 

5f6a3f6c0e8825ea329fefc6 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections