Comparative study of palonosetron with metoclopramide and ondansetron in prevention of PONV in laparoscopic cholecystectomy a randomized controlled trial

Background: Post-operative nausea and vomiting (PONV) is a ‘big little’ problem especially after laparoscopic surgeries. Palanosetron is a new potent 5 hydroxy tryptamine 3 antagonists. In this randomized double blind clinical study we compared the effects of i.v. palanosetron, ondansetron and metoclopramide administered at the end of surgery in preventing post-operative nausea and vomiting in patients undergoing laparoscopic cholecystectomy under general anesthesia.Methods: 90 ASA I/II patients of both sexes in the age group of 20-60 years over a period of 18 months undergoing laparoscopic cholecystectomy were included. The enrolled patients were randomised into three groups, Group G1 (Metoclopramide), Group G2 (Ondansetrone) and Group G3 (Palanosetron). The incidence of nausea and vomiting were monitored immediately during 0-2 h, 2-6 h, 6-24 h and 24-72 h according to the VAS.Results: Both palonosetron and ondansetron have comparable efficacy clinically and statistically in preventing nausea and were highly superior to metoclopramide in preventing nausea. Palonosetron had a better antiemetic effect than both ondansetron and metoclopramide in patients who underwent laparoscopic cholecystectomy. The number of complete responders was 8/30 (26.66%) in group G1, 20/30 (66.66%) in group G2 and 22/30 (73.33%) in group G3.Conclusion: Palonosetron has a better profile of antiemetic action, and a lesser need for rescue antiemetic postoperatively and a comparable side-effects profile as compared to ondansetron and metoclopramide