Shoulder surgery is the second most common orthopedic procedure. 1 It usually results in intense postoperative pain, the control of which may require the use of large doses of opioids. 2 Interscalene block is the standard block for shoulder surgery. It blocks the brachial plexus (BP) thereby providing adequate postoperative analgesia and improving the rehabilitation. However, it results in phrenic nerve block (PrNB) and hemi-diaphragmatic paresis which impairs the respiratory mechanics markedly. 3-8 Unfortunately, patients with limited respiratory reserve, who are at utmost need to bypass opioid-induced respiratory depression, may also not tolerate the PrNB-associated with interscalene block. 2 To preserve the respiratory function in these patients, it was suggested to use either a modified interscalene block or a distal BP block of either cords or branches. [4][5][6][7][8][9] Low volume interscalene block (LVSB), using 5 mL, was reported to provide adequate shoulder analgesia and decrease the PrNB incidence by 50% as compared with a standard block using 20 mL. 4-6 ISO (infraclavicular-subomohyoid) block, a recent single

EnAbstract Background This study aimed to evaluate the efficacy of palonosetron, the 5-hydroxytryptamine-3 (5-HT3) receptor antagonist, in preventing postoperative nausea and vomiting (PONV) after middle ear surgery. Patients and methods Sixty-two ASA I and II patients who had undergone middle ear surgery under general anesthesia were included in a double-blind, placebo-controlled study and were enrolled into two groups: palonosetron group (P) and placebo control group (C). Patients were administered 0.075 mg of palonosetron or isotonic saline, respectively. The incidence of PONV and requirement of rescue antiemetics were assessed. The severity of nausea was evaluated according to the visual analogue scale. Patients who had not experienced any attack of vomiting or received rescue drug were considered to have a complete response. Results The incidence of PONV was significantly lower in group P than that in the control group C during (0–4 h) P-value less than 0.001 and (4–24 h) 0.05 periods, and the incidence of complete response was 83.7% in group P and 6.5% in group C (P<0.001). Conclusion Palonosetron could provide effective prophylactic antiemetic control to prevent PONV after middle ear surgery under general anesthesia.

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