title: Ondansetron, ramosetron, or palonosetron: Which is a better choice of antiemetic to prevent postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy?
abstract: BACKGROUND
  Postoperative nausea and vomiting (PONV) is a serious concern in patients undergoing laparoscopic cholecystectomy (LC), with an incidence of 46 to 72%. The purpose of this study was to compare the antiemetic efficacy of intravenous (iv) ondansetron 8 mg, ramosetron 0.3 mg, and palonosetron 0.075 mg for prophylaxis of PONV in high-risk patients undergoing LC.
  
  
  METHODS
  In this prospective, randomized, double-blinded study, 87 female patients, 18 to 70 years of age (ASA I and II) and undergoing elective LC under general anesthesia were randomly allocated into three equal groups, the ondansetron group (8 mg iv; n=29), the ramosetron group (0.3 mg iv; n=29), and the palonosetron group (0.075 mg iv; n=29), and the treatments were given just after completion of surgery before extubation. The incidence of complete response (patients who had no PONV and needed no other rescue antiemetic medication), nausea, vomiting, retching, and need for rescue antiemetics over 24 hours after surgery were evaluated.
  
  
  RESULTS
  The number of complete responders were 19 (65.5%) for ramosetron, 11 (37.9%) for palonosetron, and 10 (34.5%) for ondansetron, representing a significant difference overall (P=0.034) as well as between ramosetron and ondansetron (P=0.035). Comparison between ramosetron and palonosetron also showed a clear trend favoring the former (P=0.065).
  
  
  CONCLUSIONS
  Ramosetron 0.3 mg iv was more effective than palonosetron 0.075 mg and ondansetron 8 mg in the early postoperative period, but there was no significant difference in the overall incidence of nausea suffered.
authors.affiliation: Department of Anesthesiology, Bankura Sammilani Medical College (BSMC), Bankura, West Bengal, India.
authors.forename: Sarbari
authors.initials: S
authors.lastname: Swaika
authors.affiliation: Department of Anesthesiology, Calcutta National Medical College (CNMC), Kolkata, West Bengal, India.
authors.forename: Anirban
authors.initials: A
authors.lastname: Pal
authors.affiliation: Department of Anesthesiology, Bankura Sammilani Medical College (BSMC), Bankura, West Bengal, India.
authors.forename: Surojit
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Department of Anesthesiology, Burdwan Medical College (BMC), Burdwan, West Bengal, India.
authors.forename: Debashish
authors.initials: D
authors.lastname: Saha
authors.affiliation: Specialist Medical Officer (Anesthesiology), West Bengal Health Service, West Bengal, India.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Dawar
keywords: Laparoscopic cholecystectomy; ondansetron; palonosetron; postoperative nausea and vomiting; ramosetron