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Introduction: Post operative nausea and vomiting (PONV) are often associated with the laparoscopic surgeries under general anesthesia (GA). The PONV guidelines recommended the use of 5-hydroxytryptamine receptor antagonist (5-HT3RA) as the first-line prophylactic agents in patients categorised as high-risk for emesis perioperatively. There are very few studies comparing the efficacies of combinations of newer 5HT3 RA with dexamethasone. Aim: To compare the severity of emetic episodes as well as the complete response rate to antiemetics like dexamethasone or its combination with palonosetron or ramosetron during the first 48 hours after laparoscopic surgeries. Materials and Methods: This randomised clinical double-blind study Department of Anesthesiology at Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from November 2014 to August 2016 among 90 patients, aged between 18 to 60 years belonging to the American Society of Anesthesiology (ASA) grade I and II scheduled for elective laparoscopic surgery under general anesthesia. They were randomly allocated into three equal groups. Group D received dexamethasone 8 mg, group RD received ramosetron 0.3 mg with dexamethasone 8 mg, and group PD received palonosetron 0.075 mg with dexamethasone 8 mg. Postoperative Nausea and Vomiting (PONV), retching were recorded via direct questioning or by the spontaneous complaints from the patients at 2, 6, 24, 48 hours. A scoring system was used to assess PONV. Complete response rate was also noted i.e, percentage of patients in a group with absence of nausea, retching, vomiting and no requirement of rescue antiemetic medications within postoperative 48 hours. Results: The baseline characteristics were similar in all three groups. Early and late PONV were significantly lesser with group-PD compared to group D (p-value=0.01) and group RD (p-value=0.007). The complete response rate in group PD (86.6%) was significantly highest compared to group D (40%) and group RD (76%). Rescue anlgesics required was nil in group PD compared to group D (36.3%), and group RD (10%) over 48 hours. Conclusion: Combination of palonosetron with dexamethasone is a better alternative to combination of ramosetron with dexamethasone in preventing PONV.

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BACKGROUND Isobaric levobupivacaine has minimal effect on positional variation of sensory and motor blockade given intrathecally. Also, it has lesser cardiotoxic and neurotoxic effects. Present study was done to compare efficacy, analgesia haemodynamic effects and any adverse effects after spinal anaesthesia with isobaric levobupivacaine with nalbuphine and fentanyl as adjuvants in transurethral endoscopic surgeries. METHODS 60 male adult patients of American Society of Anaesthesiologists (ASA class I-III) of age group 40 - 80 years were randomized into 2 groups (n = 30) in this prospective, double blinded study. 10 mg of 0.5 % levobupivacaine with 25 µg fentanyl in group LF and 10 mg of 0.5 % levobupivacaine with 0.8 mg nalbuphine in group LN. Parameters assessed were sensory and motor blockade characteristics and hemodynamic variables in both the groups. Adverse effects were recorded if any. RESULTS Onset of sensory and motor blockade were significantly faster in group LF compared to group LN. In both the groups, time for two segment regression was comparable. Statistically significant prolonged analgesic duration was noticed in group with nalbuphine than fentanyl as adjuvant to isobaric levobupivacaine. Difference in haemodynamic variation was not significant in both the groups. CONCLUSIONS Intrathecal nalbuphine 0.8 mg as an adjuvant with isobaric levobupivacaine 0.5 % 10 mg is as efficacious as fentanyl 25µg in transurethral endoscopic surgeries in elderly population with better hemodynamic stability. KEY WORDS Levobupivacaine; Fentanyl; Nalbuphine; Spinal anaesthesia.