Anti-emetic effect of ondansetron and palonosetron in thyroidectomy: a prospective, randomized, double-blind study

• Published in: British journal of anaesthesia : BJA Vol. 108; no. 3; pp. 417 - 422
• Main Authors: Moon, Y.E., Joo, J., Kim, J.E., Lee, Y.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.03.2012; Oxford University Press
• Subjects: Adult; analgesia, patient-controlled; Analgesia, Patient-Controlled - adverse effects; Analgesics, Opioid - adverse effects; Analgesics, Opioid - therapeutic use; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; anti-emetics, ondansetron; anti-emetics, palonosetron; Antiemetics - adverse effects; Antiemetics - therapeutic use; Biological and medical sciences; Double-Blind Method; Female; Humans; Isoquinolines - adverse effects; Isoquinolines - therapeutic use; Medical sciences; Middle Aged; Ondansetron - adverse effects; Ondansetron - therapeutic use; Pain Measurement - methods; Pain, Postoperative - prevention & control; Postoperative Care - methods; postoperative nausea and vomiting; Postoperative Nausea and Vomiting - etiology; Postoperative Nausea and Vomiting - prevention & control; Quinuclidines - adverse effects; Quinuclidines - therapeutic use; Thyroidectomy - adverse effects; Treatment Outcome; Young Adult; anti-emetics, ondansetron; analgesia, patient-controlled; anti-emetics, palonosetron; postoperative nausea and vomiting; analgesia, patient-controlled; anti-emetics, ondansetron; anti-emetics, palonosetron; Human; Postoperative; Serotonin antagonist; Nausea; anti-emetics; Palonosetron; Analgesia; patient-controlled; Vomiting; 5-HT3 Serotonine receptor; Double blind study; Digestive diseases; Anesthesia; Antiemetic; Ondansetron; Emetic
• ISSN: 0007-0912; 1471-6771; 1471-6771
• DOI: 10.1093/bja/aer423

Palonosetron is a new potent 5-hydroxytryptamine 3 antagonist. Although this drug is thought to be more effective in patients receiving opioid-based patient-controlled analgesia (PCA), clinical data are lacking. This study compared the effects of i.v. ondansetron and palonosetron administered at the end of surgery in preventing postoperative nausea and vomiting (PONV) in high-risk patients receiving i.v. PCA after thyroidectomy. A total of 100 female non-smoking subjects were randomly assigned into a palonosetron group or an ondansetron group. Ondansetron was given as an 8 mg bolus and 16 mg was added to the i.v. PCA mixture. In the palonosetron group, 0.075 mg was injected as a bolus only. Fentanyl-based PCA was provided for 24 h after operation. The incidence of nausea and vomiting, severity of nausea, requirement for rescue anti-emetics, and adverse effects were evaluated during 0–2 and 2–24 h. The incidence of PONV during the 24 h postoperative period was lower in the palonosetron group than in the ondansetron group (42% vs 62%, P=0.045). No differences were observed between the groups during the first 2 h. However, the incidence of nausea and vomiting and nausea severity were significantly lower in the palonosetron group than in the ondansetron group during 2–24 h. The only difference in the use of rescue anti-emetics was at 2–24 h (10% with palonosetron compared with 28% with ondansetron, P=0.02). Palonosetron is more effective than ondansetron for high-risk patients receiving fentanyl-based PCA after thyroidectomy, especially 2–24 h after surgery.