Palonosetron versus ondansetron for prevention of nausea and vomiting after total abdominal hysterectomy under spinal anesthesia with intrathecal morphine: a double-blind, randomized controlled trial

Abstract

Background Hysterectomy is a widely performed surgery and neuraxial anesthesia with intrathecal morphine provides superior quality of recovery. Postoperative nausea and vomiting (PONV) is a frequent problem with intrathecal morphine use. Although palonosetron is effective for prevention of PONV after general anesthesia, its efficacy after neuraxial anesthesia has not been established. This study was conducted to compare the use of palonosetron with ondansetron for PONV prophylaxis in patients at a high risk of PONV during total abdominal hysterectomy (TAH) under spinal anesthesia with intrathecal morphine. Methods This prospective, randomized double-blind study conducted at São Rafael Hospital involved 140 American Society of Anesthesiologists physical status I or II women who underwent TAH under spinal anesthesia with intrathecal morphine and who had at least 3 risk factors for PONV based on Apfel’s simplified score. The patients were randomized into two groups: one received palonosetron whereas the other received ondansetron. All patients received spinal anesthesia with intrathecal morphine, as well as dexamethasone plus palonosetron or ondansetron for PONV prophylaxis. The overall incidence of PONV, incidence of early- and late-onset nausea and vomiting, severity of nausea, and use of rescue antiemetics were recorded. Results The overall incidence of PONV was 42.9% in the palonosetron group and 52.9% in the ondansetron group ( p > 0.05). No significant differences existed in the incidence of early- and late-onset nausea or early-onset vomiting between the two groups. The incidence of late-onset vomiting was significantly lower in the palonosetron group. Conclusions Palonosetron exhibited efficacy similar to that of ondansetron for reducing the overall incidence of PONV after TAH under spinal anesthesia with intrathecal morphine; however, palonosetron reduced the incidence of late-onset vomiting significantly better than ondansetron. Trial registration RBR-4gnm8n ( ensaiosclinicos.gov.br ), date of registration: August 18, 2014.

Comparison of General Anesthesia With Spinal Anesthesia on the Quality of Recovery of Patients With Selective Abdominal Hysterectomy in Patients Vising the Largest Women’s Disease Hospital in Northwestern Iran

“…However, the frequency of nausea/vomiting and the need for treatment were greater in the GA group compared to the SA group. In this regard, the results of similar studies (26,27) indicated that GA causes more nausea and vomiting than other methods, increasing the need for antiemetic medications. Nausea and vomiting in surgeries (e.g., hysterectomy) can put pressure on the intestines and the lower gastrointestinal tract, which can have adverse effects on the results of hysterectomy.…”

Prevention and Treatment of Postoperative Nausea and Vomiting (PONV): A Review of Current Recommendations and Emerging Therapies

“…On the other hand, several studies have compared the efficacy of palonosetron plus dexamethasone to ondansetron plus dexamethasone, while the results appear to favor palonosetron plus dexamethasone, and the difference was not statistically significant. 83–88 …”

The Effect of Propofol plus Remifentanil for PostoperativePain and Heart Rate Management in Patients Undergoing Abdominal Hysterectomy

“…Abdominal hysterectomy is applicable for patients with obvious symptoms, no fertility requirements, or possible malignant changes [ 2 ]. A hysterectomy typically is performed under general anesthesia [ 3 ]. Research has indicated that postoperative stress is associated with factors such as the method of anesthesia and surgical procedures [ 4 ].…”