Efficacy of palonosetron and ramosetron on postoperative nausea and vomiting related to intravenous patient-controlled analgesia with opioids after gynecological laparoscopic surgery (double-blinded prospective randomized controlled trial).
OBJECTIVE
The study was designed to assess the efficacy of palonosetron and ramosetron in preventing postoperative nausea and vomiting (PONV) related to intravenous (IV) patient-controlled analgesia (PCA) with opioids after gynecological laparoscopic surgery.


METHODS
Patients were randomly allocated to 4 groups-C, P, R0.3 and RPCA. At the end of surgery, group C received an infusion of 50 ml normal saline, group P received palonosetron 75 μg mixed in 50 ml normal saline, and groups R0.3 and RPCA received ramosetron 0.3 mg mixed in 50 ml normal saline. A PCA pump containing fentanyl was connected for all groups; however, ramosetron 0.6 mg was mixed with the PCA regimen for the RPCA group. PONV and postoperative pain were assessed.


RESULTS
PONV incidence and scale, and Rhodes index in RPCA group between 24 and 72 h after discharge from the post-anesthetic care unit (PACU) showed significantly lower values, compared with the other groups. PONV incidence and scale, and Rhodes index in P group and R0.3 group were lower than the corresponding values in C group at all times, without statistical significance.


CONCLUSIONS
A single dose of palonosetron 75 μg or ramosetron 0.3 mg was unable to prevent PONV related to IV PCA with opioids in patients undergoing gynecological laparoscopic surgery. The combination of a single dose of ramosetron 0.3 mg, followed by ramosetron 0.6 mg mixed with PCA, significantly decreased PONV compared with a single dose of palonosetron 75 μg or ramosetron 0.3 mg.
Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1, Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 143-729, Korea, yshkim75@daum.net.
Seong-Hyop
SH
Kim
Chung-Sik
CS
Oh
Sun Joo
SJ
Lee
D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000932:Antiemetics / Q000627:therapeutic use*; D001562:Benzimidazoles / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007546:Isoquinolines / Q000008:administration & dosage*; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy; D000077924:Palonosetron; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy*; D011446:Prospective Studies; D011812:Quinuclidines / Q000008:administration & dosage*
D000701:Analgesics, Opioid; D000932:Antiemetics; D001562:Benzimidazoles; D007546:Isoquinolines; D011812:Quinuclidines; D000077924:Palonosetron; C071315:ramosetron; D005283:Fentanyl