title: Intravenous palonosetron compared with a combination of ramosetron and dexamethasone in preventing post operative nausea and vomiting in patients undergoing gynaecological surgeries under spinal anaesthesia, a randomised study.
abstract: OBJECTIVE
  Post-operative nausea and vomiting (PONV) is one of the most common complications in patients undergoing gynaecological surgeries under spinal anaesthesia (SA). Palonosetron has the unique property of controlling 'delayed chemotherapy-induced nausea and vomiting' when compared to older serotonin antagonists. This study compared the effectiveness of palonosetron with a combination of ramosetron and dexamethasone in preventing PONV.
  
  
  METHODS
  Sixty patients undergoing gynaecological surgeries under SA were randomly allocated into two groups of thirty each, to receive either a combination of 0.3 mg of ramosetron and 8 mg of dexamethasone intravenously (IV) (Group RD) or 0.075 mg of palonosetron IV (Group P). The incidence of PONV, number of complete responders (no nausea, vomiting or use of rescue anti-emetics) and severity of nausea were evaluated during intra- and post-operative period.
  
  
  RESULTS
  The incidence of complete responders during intraoperative period was 80.0% in Group RD and 76.7% in Group P (P= 0.074) whereas postoperatively at 0-2 h and 2-6 h, it was 73.3% and 83.3% in Group RD respectively as compared to 46.6% and 56.6% in Group P respectively (P= 0.016 andP= 0.024). The incidence of PONV during 24 h of post-operative period was 30.00% in Group RD as compared to 60.00% in Group P (P= 0.0195). Nausea severity score and use of rescue anti-emetics did not vary between the groups.
  
  
  CONCLUSIONS
  Combination of ramosetron and dexamethasone is more effective than palonosetron alone in preventing PONV in patients undergoing gynaecological surgeries under SA.
authors.affiliation: Department of Anaesthesia, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.
authors.forename: Archana B
authors.initials: AB
authors.lastname: Narayanappa
authors.affiliation: Department of Anaesthesia, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.
authors.forename: Shivakumar
authors.initials: S
authors.lastname: Gurulingaswamy
authors.affiliation: Department of Anaesthesia, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.
authors.forename: Umesh N
authors.initials: UN
authors.lastname: Prabhakaraiah
authors.affiliation: Department of Anaesthesia, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.
authors.forename: Somsundar R
authors.initials: SR
authors.lastname: Gurushanth
authors.affiliation: Department of Anaesthesia, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Sapare
authors.affiliation: Department of Community Medicine, Mandya Institute of Medical Sciences, Mandya, Karnataka, India.
authors.forename: Nagaraj
authors.initials: N
authors.lastname: Goud
keywords: Palonosetron; post-operative nausea and vomiting; ramosetron and dexamethasone