Comparative Study Of Efficacy Of Palonosetron With Dexamethasone Versus Granisetron With Dexamethosone In Laproscopic Abdominal Surgeries For Control Of Post Operative Nausea And Vomiting
Efficacy Of 5HT3 Antagonists With Dexona For PONV
DOI:
https://doi.org/10.70284/njirm.v7i1.1036Keywords:
Dexamethasone, Granisetron, Laproscopic Surgeries, Palonosetron, Postoperative Nausea and VomitingAbstract
Background & Aim: This study was carried out to demonstrate the efficacy and compare a dose of Granisetron with Dexamethasone and Palonosetron with Dexamethasone for prophylaxis against postoperative nausea and vomiting. Aim is to study the effectiveness of palonosetron and granisetron with aims of evaluating the efficacy of palonosetron and granisetron with dexamethasone in prevention of postoperative nausea and vomiting and to study associated adverse effects. The study was carried out in Civil Hospital, Ahmedabad with prior permission of ethical committee of the hospital. Methodology: This study was designed to evaluate the efficacy and compare a dose of study drugs in 60 patients of either sex and age ranging from 18 to 60 years and physical status ASA risk I or II undergoing general anaesthesia for various laparoscopic surgical procedures. Patients were divided into 2 groups(n=30), assigned to receive granisetron 1mg plus dexamethasone 8mg i.v and palonosetron 0.075mg plus dexamethasone 8mg i.v. A standard general anaesthesia technique and post operative analgesia were used throughout our study. The groups were compared with regards to the incidence of complete response, mean PONV score, mean nausea VDS scores and requirement of rescue anti emetics drug at various intervals (0-6,6-24,24-72hrs). Differences in continuous variables (age and duration of anaesthesia) across two dosage groups were compared using analysis of variance (ANOVA) test which is a parametric statistical test. Differences in categorical variables (gender, presence of complete response, use of rescue anti-emetics) across two dosage groups were compared using chi square test. Differences in ordinal variables (PONV scores and 4-point verbal descriptive nausea scores) across two dosage groups were compared using non-parametric Kruskal Wallis one-way analysis of variance. Mann Whitney U test was used to conduct sub-group analyses for comparing PONV scores and 4-point verbal descriptive nausea scale scores between two given groups. McNemar's test was done to compare differences in rates of complete response in a given dosage group across different time periods of assessment. Results: Our study results shows clear superiority of palonosetron with dexamethasone as a prophylactic drug for the prevention of PONV than that of granisetron with dexamethasone. Conclusions: Due to its longer duration of action, a single dose of palonosetron with dexamethasone before induction is effective in preventing PONV for upto 72 hours and hence can be termed as a prophylactic drug for PDNV also. It’s optimal and effective dose is 0.075mg i.v. with minimal side effects. [Patel K NJIRM 2016; 7(1):16-22]
References
2. Muchatuta NA, Paech MJ. Management of postoperative nausea and vomiting: focus on palonosetron. Ther Clin Risk Manag 2009;5(1):21-34.
3. Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg 2006;102(6):1884-98.
4. Apfel CC, Laara 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(3):693-700.
5. Aapro MS. Palonosetron as an anti-emetic and anti-nausea agent in oncology. Ther Clin Risk Manag 2007;3(6):1009-1020.
6. Wong EH, Clark R, Leung E, Loury D, Bonhaus DW, Jakeman L et al. The interaction of RS 25259-197, a potent and selective antagonist, with 5-HT3 receptors, in vitro. Br J Pharmacol 1995;114(4):851-9.
7. Stoltz R, Cyong JC, Shah A, Parisi S. Pharmacokinetic and safety evaluation of palonosetron, a 5-hydroxytryptamine-3 receptor antagonist, in U.S. and Japanese healthy subjects. J Clin Pharmacol 2004;44(5):520-31.
8. Iitomi T, Toriumi S, Kondo A, Akazawa T, Nakahara T. Incidence of nausea and vomiting after cholecystectomy performed via laparotomy or laparoscopy. Masui 1995;44 (12):1627-31.
9. Tsuji D, Kim YI, Taku K, Nakagaki S, Ikematsu Y, Tsubota H, Maeda M et al. Comparative trial of two intravenous doses of granisetron (1 versus 3 mg) in the prevention of chemotherapy-induced acute emesis 2001: a double-blind, randomized, non-inferiority trial. Support Care Cancer 2012;20(5):1057-64.
10.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(2):445-51.
11. Aspinall RL, Goodman NW. Denial of effective treatment and poor quality of clinical information in placebo controlled trials of ondansetron for postoperative nausea and vomiting: a review of published trials. Br J Anaesth 1995;311(7009):844-6.
12.Wilson AJ, Diemunsch P, Lindeque BG, Scheinin H, Helbo-Hansen HS, Kroeks MV et al. Single-dose i.v. granisetron in the prevention of postoperative nausea and vomiting. Br J Anaesth 1996;76(4):515-8.
13. 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(2):439-44.
14. Wallenborn J, Kaisers U, Roewer N, Kranke P. Palonosetron in the prevention of postoperative nausea and vomiting (PONV): A quantitative systematic review : 1AP7-2. European Journal of Anaesthesiology 2010;27(47):24.
15. Lichtor JL, Glass PS . We're tired of waiting. Anesth Analg 2008;107(2):353-5.
16. Rojas C, Stathis M, Thomas AG, Massuda EB, Alt J, Zhang J et al. Palonosetron exhibits unique molecular interactions with 5-HT3 receptor. Anesth Analg 2008;107(2):469-78.
