Palonosetron-dexamethasone versus ondansetron-dexamethasone to prevent postoperative nausea and vomiting undergoing laparoscopic sleeve gastrectomy: a preliminary, randomized, double blinded study

Introduction: Post-operative nausea and vomiting (PONV) is associated with wound dehiscence, pulmonary aspiration, electrolyte disturbances, delayed recovery and patient dis-satisfaction. The present study was aimed to compare antiemetic efficacy of intravenous palonosetron with dexamethasone versus ondansetron with dexamethasone to prevent PONV in patient undergoing laparoscopic sleeve gastrectomy (LSG). Materials and Method: Prospective, double blind randomized study of 24 morbidly obese patients planned for LSG. Preoperative gastric emptying scintigraphy (GES) done to know about gastric emptying. All patients premedicated with tablet ranitidine 150 mg a night before and 2 hours before surgery. Patients randomized into two groups PD (n=12) and OD (n=12) according to antiemetic agents used 30 min prior induction. Perioperative hemodynamic parameter were measured every 10 min interval during intraoperative and incidence of PONV along with hemodynamic parameters were assessed at arrival 0, 6, 12, 24, 48 and 72 hours postoperative period. Observation and Results: Demographic data, perioperative hemodynamic parameters were well matched. The overall incidence of nausea/vomiting was 54.6%/18.2% and 63.6%/18.2% in group PD and group OD; respectively during 72 hours follow-up. The total dose of rescue antiemetic was 10 mg in group PD and 11.67 in group OD (p=3.14). GES done in 8 patients (PD; 3 and OD; 5) indicated normal gastric emptying and only one patient had PONV in this subset. Conclusions: In this preliminary study, palonosetron and ondansetron in combination with dexamethasone had comparable antiemetic efficacy after LSG. Further studies can be conducted to find-out the role of preoperative GES as a tool to predict PONV.