A Comparison of Ondansetron, Palonosetron and Granisetron for Prevention of Post-Operative Nausea and Vomiting after Laparoscopic Surgeries

BACKGROUNDPost-Operative Nausea and Vomiting (PONV) "the little big problem" after surgery/anaesthesia is a common side-effect which compromises the quality of care, delays discharge and thereby delays resumption of activities of daily living.A number of pharmacological agents (antihistamines, butyrophenones, dopamine receptor antagonists) have been used, and the 5-hydroxytryptamine type 3 receptor antagonists have been found to be effective in prevention and treatment of PONV.Thus, we compared the prophylactic effects of intravenously administered ondansetron, palonosetron, and granisetron in prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery under general anaesthesia. METHODSThis prospective, double blind study, comprising of 135 patients of ASA physical status I and II of either gender, was carried out after approval was obtained from the Institutional Ethical and Scientific Committee.Patients were randomized into three equal groups.Group P received inj.palonosetron (0.075 mg), group O received inj.ondansetron (8 mg), and group G received inj.granisetron (2.5 mg) intravenously five minutes before induction of anaesthesia.The episodes of postoperative nausea and vomiting, severity of nausea, need for rescue antiemetic, side effects and patient satisfaction were observed in the study groups for 24 hours in the post-operative period.At the end of study, results were compiled, and statistical analysis was done using ANOVA, chi-square test, and Kruskal Wallis Test.Value of p < 0.05 was considered significant. RESULTSThe incidence of PONV was significantly less in the palonosetron group (95.6%) as compared to the ondansetron group (80%) and granisetron group (73.3%), with a lesser need for rescue antiemetic in the palonosetron group.All the three study groups did not have significant adverse effects reflecting that all the three drugs were well-tolerated.Patient satisfaction score was also more with palonosetron. CONCLUSIONSPalonosetron was more effective in prevention of PONV after anaesthesia due to its prolonged duration of action than ondansetron and granisetron.