Comparison of palonosetron, dexamethasone, and palonosetron plus dexamethasone as prophylactic antiemetic and antipruritic drug in patients receiving intrathecal morphine for lower segment cesarean section

Abstract

Background:Intrathecal morphine is commonly used for postcesarean analgesia. Its use is frequently associated with opioid-induced nausea, vomiting, and pruritus. Palonosetron (0.075 mg) combined with dexamethasone (8 mg) is postulated to have an additive effect over each drug alone. The study, therefore, compared the effect of intravenous (i.v.) palonosetron, dexamethasone, and palonosetron with dexamethasone combination in preventing intrathecal morphine-induced postoperative vomiting and pruritus in lower segment cesarean section (LSCS) patients.Settings and Design:Randomized, prospective, double-blinded, observational clinical study.Methods:Ninety pregnant women, American Society of Anesthesiologists physical status class I undergoing LSCS were included in the study. They were randomly assigned to three groups – Group P received 0.075 mg palonosetron i.v., Group D received dexamethasone 8 mg i.v., and Group PD received palonosetron 0.075 mg along with dexamethasone 4 mg i.v., just after spinal anesthesia with bupivacaine 2.2 ml (12 mg) and 150 μg morphine. The incidence of pruritus, nausea, vomiting, and need for rescue drug were recorded for 24 h.Statistical Analysis:Statistical analysis was performed using Student's t-test for categorical variables and Chi-square test for noncategorical variables.Results:The incidence of nausea, vomiting was significantly more in Group D (40%) than Group P (27%) and Group PD (20%) in 24 h. The incidence of pruritus was significantly more in Group D (6%) than Group P and PD (3%). The need of rescue antiemetic was more in Group D (30%) than Group P (6%) and Group PD (3%). No difference in three groups requiring rescue antipruritic drug.Conclusion:Prevention of intrathecal morphine-induced vomiting and pruritus was more effective with palonosetron alone or with dexamethasone combination than dexamethasone alone. Combination of palonosetron and dexamethasone proved no better than palonosetron alone.

Ondansetron for the Prevention of Pruritus in Women Undergoing Cesarean Delivery With Intrathecal Opioid: A Systematic Review and Meta-Analysis

“…19,55,56,70,71 Palonosetron, a newer 5-HT 3 receptor antagonist with longer duration of action and reduced effect on the QTc, has shown some promising effects in the limited studies into its effect on pruritus to date. [72][73][74] This study along with the George and Wang metaanalyses did not show a dose response relationship with increasing doses of ondansetron. 18,19 Of note, the 3 studies included in this analysis that compared 4 mg vs 8 mg of ondansetron and the study that compared 0.05 mg/kg and 0.1 mg/kg ondansetron all failed to show any dose-dependent response.…”

“…19,55,56,70,71 Palonosetron, a newer 5-HT 3 receptor antagonist with longer duration of action and reduced effect on the QTc, has shown some promising effects in the limited studies into its effect on pruritus to date. 72–74…”

A comparison of prophylactic antiemetic therapy with palonosetron and dexamethasone as single-agents or in combination in adult patients undergoing laparoscopic surgery

“…It was reported that palonosetron alone and a combination of palonosetron–dexamethasone were equally effective in the prevention of PONV; however, dexamethasone alone was least effective among the three groups. [ 19 20 ] The combination of palonosetron–dexamethasone was more effective as compared to only palonosetron for reducing PONV after laparoscopic cholecystectomy. [ 21 ] However, in our study, we observed that the combination of palonosetron–dexamethasone did not significantly reduce the incidence of PONV when compared with either drug alone.…”

A prospective, randomized, double-blind trial to compare body weight-adjusted and fixed doses of palonosetron for preventing postoperative nausea and vomiting in obese female patients

“…In the present study, only non-smoking female patients were recruited because this population has a high risk of PONV [1,15]. The impact of body weight on determining the dose of palonosetron has not yet been investigated; therefore, only obese patients were enrolled.…”