The effect of combination treatment using palonosetron and dexamethasone for the prevention of postoperative nausea and vomiting versus dexamethasone alone in women receiving intravenous patient-controlled analgesia

Ryoo, Seung-Hwa; Yoo, Jae Hwa; Kim, Mun Gyu; Lee, Ki Hoon; Kim, Soon Im

doi:10.4097/kjae.2015.68.3.267

Cited by 12 publications

(12 citation statements)

References 30 publications

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“…Literature describes dexamethasone as an effective drug to prevent PONV ( 6 – 8 , 13 ). These data show it to be an inexpensive and excellent antiemetic prophylactic agent commonly used worldwide, especially if it is administrated early before surgery ( 6 – 8 , 13 ). Its mechanism of action remains undetermined; most likely, its peripherally prostaglandin antagonism, serotonergic antagonism, and endorphin releasing properties play important roles in PONV management.…”

Section: Introductionmentioning

confidence: 99%

“…Palonosetron is the latest serotonin receptor antagonist ( 3 , 6 – 8 , 13 , 16 , 17 ). Serotonin is an ubiquitous central and peripheral neurotransmitter thought to be the predominant mediator of the perception of nausea and triggering of the vomiting response ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

“…Palonosetron, compared to older 5-HT3 receptor antagonist, such as ondansetron, granisetron, dolasetron, and ramosetron, has higher receptor binding affinity and longer plasma half-life (40 h) ( 3 , 6 – 8 , 13 , 16 , 17 ). The most effective dose for PONV is a single 0.075 mg IV dose administered over 10 s right before anesthesia induction ( 5 , 6 , 12 , 13 ). The most common side effects of palonosetron described in the literature are electrocardiogram QT prolongation, bradycardia, headache, and constipation ( 18 , 20 ).…”

Section: Introductionmentioning

confidence: 99%

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The Effect of a Combination Treatment Using Palonosetron, Promethazine, and Dexamethasone on the Prophylaxis of Postoperative Nausea and Vomiting and QTc Interval Duration in Patients Undergoing Craniotomy under General Anesthesia: A Pilot Study

et al. 2016

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IntroductionPostoperative nausea and vomiting (PONV) is a displeasing experience that distresses surgical patients during the first 24 h after a surgical procedure. The incidence of postoperative nausea occurs in about 50%, the incidence of postoperative vomiting is about 30%, and in high-risk patients, the PONV rate could be as high as 80%. Therefore, the study design of this single arm, non-randomized, pilot study assessed the efficacy and safety profile of a triple therapy combination with palonosetron, dexamethasone, and promethazine to prevent PONV in patients undergoing craniotomies under general anesthesia.MethodsThe research protocol was approved by the institutional review board and 40 subjects were provided written informed consent. At induction of anesthesia, a triple therapy of palonosetron 0.075 mg IV, dexamethasone 10 mg IV, and promethazine 25 mg IV was given as PONV prophylaxis. After surgery, subjects were transferred to the surgical intensive care unit or post anesthesia care unit as clinically indicated. Ondansetron 4 mg IV was administered as primary rescue medication to subjects with PONV symptoms. PONV was assessed and collected every 24 h for 5 days via direct interview and/or medical charts review.ResultsThe overall incidence of PONV during the first 24 h after surgery was 30% (n = 12). The incidence of nausea and emesis 24 h after surgery was 30% (n = 12) and 7.5% (n = 3), respectively. The mean time to first emetic episode, first rescue, and first significant nausea was 31.3 (±33.6), 15.1 (±25.8), and 21.1 (±25.4) hours, respectively. The overall incidence of nausea and vomiting after 24–120 h period after surgery was 30% (n = 12). The percentage of subjects without emesis episodes over 24–120 h postoperatively was 70% (n = 28). No subjects presented a prolonged QTc interval ≥500 ms before and/or after surgery.ConclusionOur data demonstrated that this triple therapy regimen may be an adequate alternative regimen for the treatment of PONV in patients undergoing neurological surgery under general anesthesia. More studies with a control group should be performed to demonstrate the efficacy of this regimen and that palonosetron is a low risk for QTc prolongation.ClinicalTrials.gov IdentifierNCT02635828 ().

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effect of a Combination Treatment Using Palonosetron, Promethazine, and Dexamethasone on the Prophylaxis of Postoperative Nausea and Vomiting and QTc Interval Duration in Patients Undergoing Craniotomy under General Anesthesia: A Pilot Study

et al. 2016

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“…Serotonin 5-hydroxytryptamine type 3 (5-HT 3 ) receptor antagonists have been commonly used to prevent chemotherapy-induced nausea and vomiting, as well as PONV [ 9 10 ]. Compared with older 5-HT 3 receptor antagonists, palonosetron has been widely used in recent years because of its advantages such as no QT c prolongation and longer half-life.…”

Section: Introductionmentioning

confidence: 99%

A comparison of palonosetron and dexamethasone for postoperative nausea and vomiting in orthopedic patients receiving patient-controlled epidural analgesia

Kim

Lim

et al. 2017

Korean J Anesthesiol

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BackgroundPostoperative nausea and vomiting (PONV) is one of the major concerns after anesthesia and surgery, and it may be more frequent in orthopedic patients receiving patient-controlled epidural analgesia (PCEA). The purpose of this study was to compare the effect of palonosetron and dexamethasone on the prevention of PONV in patients undergoing total joint arthroplasty and receiving PCEA.MethodsPatients scheduled for total hip or knee arthroplasty under spinal anesthesia/PCEA were randomly allocated to receive either intravenous palonosetron (0.075 mg, n = 50) or dexamethasone (5 mg, n = 50). Treatments were administered intravenously to the patients 30 min before the beginning of surgery. The total incidence of PONV and incidence in each time period, severity of nausea, need for rescue anti-emetics, pain score, and adverse effects during the first 48 h postoperatively were evaluated.ResultsThe total incidence of PONV was lower in the palonosetron group compared with the dexamethasone group (18.4% vs. 36.7%, P = 0.042), but there were no statistically significant differences in incidence between the groups at all time points. No significant intergroup differences were observed in the severity of nausea, use of rescue anti-emetics, pain score, and adverse effects.ConclusionsAlthough there were no significant differences in the incidence of PONV between the treatment groups at all time points, intravenous palonosetron reduced the total incidence of PONV in orthopedic patients receiving PCEA compared with dexamethasone.

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“…However, since palonosetron is quite expensive (~438 RMB/0.25 mg), a higher dose of palonosetron can result in an increased economic burden for patients. It has previously been suggested that a combination of two different antiemetics is more effective than monotherapy in preventing PONV 6,7. Therefore, it was hypothesized that a combination therapy could achieve equivalent efficacy and cost less compared with monotherapy using a higher dose of palonosetron.…”

Section: Introductionmentioning

confidence: 99%

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

Tan

Gong

2017

DDDT

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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.

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The effect of combination treatment using palonosetron and dexamethasone for the prevention of postoperative nausea and vomiting versus dexamethasone alone in women receiving intravenous patient-controlled analgesia

Cited by 12 publications

References 30 publications

The Effect of a Combination Treatment Using Palonosetron, Promethazine, and Dexamethasone on the Prophylaxis of Postoperative Nausea and Vomiting and QTc Interval Duration in Patients Undergoing Craniotomy under General Anesthesia: A Pilot Study

The Effect of a Combination Treatment Using Palonosetron, Promethazine, and Dexamethasone on the Prophylaxis of Postoperative Nausea and Vomiting and QTc Interval Duration in Patients Undergoing Craniotomy under General Anesthesia: A Pilot Study

A comparison of palonosetron and dexamethasone for postoperative nausea and vomiting in orthopedic patients receiving patient-controlled epidural analgesia

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

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