Higher dose of palonosetron versus lower dose of palonosetron plus droperidol to prevent postoperative nausea and vomiting after eye enucleation and orbital hydroxyapatite implant surgery: a randomized, double-blind trial

Abstract

ObjectivePostoperative nausea and vomiting (PONV) is commonly observed after eye enucleation and orbital hydroxyapatite implant surgery. This prospective, randomized, double-blind trial was conducted to investigate the hypothesis that compared with monotherapy using a higher dose of palonosetron, using a lower dose of palonosetron in combination with droperidol could reduce the incidence of PONV and achieve similar prophylaxis against PONV after the aforementioned surgery.Patients and methodsA total of 129 patients who were in the American Society of Anesthesiologists Classes I and II, aged between 18 and 70 years, and scheduled for eye enucleation and orbital hydroxyapatite implant surgery, were enrolled in this study. They were randomized into three groups: Group P2.5 (2.5 μg/kg palonosetron), Group P7.5 (7.5 μg/kg palonosetron), and Group P+D (2.5 μg/kg palonosetron and 15 μg/kg droperidol). Patients received the different antiemetic regimens intravenously 5 min before surgery. The severity of nausea and vomiting and the complete response (CR) rate during a 72-h postoperative period were assessed.ResultsAll patients completed the trial. The nausea score of Group P2.5 was significantly higher than those of the other two groups at 0–4 h and 24–48 h (P<0.05). Vomiting scores among all groups were similar during all intervals (P>0.05). Compared with Group P2.5, the CR rate was significantly improved at all intervals in Group P+D, except at 4–72 h, and was also elevated at 24–72 h in Group P7.5 (P<0.05). Fewer patients in Group P2.5 did not experience any nausea or vomiting throughout the study (49%) compared with those in Group P7.5 (67%) and Group P+D (81%; P<0.01).ConclusionCombining low-dose palonosetron with droperidol potentiated prophylaxis for PONV and achieved a similar prophylactic effect as that with a higher dose of palonosetron.

Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review

“…Hu et al . 425 combined a low dose of 2.5 μg/kg palonosetron with 15 μg/kg of droperidol and achieved a similar prophylactic effect as a higher 7.5 μg/kg dose of palonosetron compared to 7.5 μg/kg alone for treating emesis after eye surgery. For the treatment of existing PONV prior to discharge, a multimodal strategy should be considered because the recurrence rate of PONV over the subsequent 24 hours is 35–50% 426 .…”

The application of an acellular dermal allograft (AlloDerm) for patients with insufficient conjunctiva during evisceration and implantation surgery

“…8 Neovascularisation has been observed in animal models grafted with AlloDerm. 9 AlloDerm skin grafts have been used to treat burn victims, 10,11 to support abdominal or parastomal hernias, 12 in breast reconstruction, 13 to reconstruct longsegment tracheal defects (serving as a conduit) 14 and to reconstruct anterior skull-base defects. 15 In oculoplastic and orbital surgery, we often encountered cases of insufficient orbital and periorbital soft tissue volume.…”