Effect of palonesetron, ondasetron and dexamethasone or dexamethasone for prevention of postoperative nausea and vomiting in videocolecistectomy with total venous anesthesia with propofol-remifentanil - randomized clinical trial

Rationale and objectives:
Postoperative nausea and vomiting (PONV) after video cholecystectomy have a high rate. Advances in pharmacological PONV prophylaxis with a new generation of 5-HT3 antagonists have been submitted to examination. This study aims to evaluate the effect of the 5-HT3 antagonist in postanesthetic antiemetic control of video cholecystectomy under total intravenous anesthesia.
Method:
Sixty individuals who underwent videocolecistectomy were randomized into 3 groups of equal numbers, with 0.125 mg of palonosetron (group 1), or 4 mg of ondansetron and 4 mg of dexamethasone (group 2) or 4 mg of dexamethasone (group 3). The procedure was performed with propofol, remifentanil, and rocuronium. The evaluator of the effect of the drug was unaware of the group to which the participant belonged. PONV was assessed using the Rhodes Scale at 12 and 24 hours after surgery. A dose of 0.655 to 1.5 mg of droperidol was set for rescue therapy.
Results:
A lower incidence of PONV and the need for rescue therapy during the first hour was observed in Group 1. No significant differences were found between the three groups with regard to the incidence of PONV in the first 12 hours of the postoperative period. The control of PONV in 12 to 24 hours and after the 12-24 hours rescue therapy was higher in groups I and II than in Group 3. Nausea control in the first 12 hours of the postoperative period in Group I was significantly higher than the other methods used.
Conclusion:
This study showed evidence that palonosetron is superior to other drugs in relation to the prolonged antiemetic effect and lower need of rescue therapy, especially in the ability to completely inhibit the uncomfortable symptoms of nausea.

研究背景与目的：
腹腔镜胆囊切除术（video cholecystectomy）后术后恶心呕吐（Postoperative nausea and vomiting, PONV）发生率较高。新一代5-HT3受体拮抗剂（5-HT3 antagonists）用于术后恶心呕吐预防的药理学进展已得到相关验证。本研究旨在评估全凭静脉麻醉（total intravenous anesthesia）下，5-HT3受体拮抗剂在腹腔镜胆囊切除术患者术后麻醉止吐管理中的应用效果。

研究方法：
将60名接受腹腔镜胆囊切除术的患者随机均分为三组：第1组给予0.125mg帕洛诺司琼（palonosetron），第2组给予4mg昂丹司琼（ondansetron）联合4mg地塞米松（dexamethasone），第3组仅给予4mg地塞米松。本研究采用丙泊酚（propofol）、瑞芬太尼（remifentanil）与罗库溴铵（rocuronium）实施麻醉。疗效评估者采用盲法，对患者所属分组不知情。分别于术后12小时与24小时采用罗德量表（Rhodes Scale）评估术后恶心呕吐发生情况。急救止吐治疗预设剂量为0.655~1.5mg氟哌利多（droperidol）。

研究结果：
第1组术后1小时内术后恶心呕吐发生率与急救治疗需求均更低。术后前12小时内，三组术后恶心呕吐发生率无显著差异。术后12~24小时时段及该时段急救治疗后的术后恶心呕吐控制效果，第1、2组均优于第3组。术后前12小时的恶心症状控制效果，第1组显著优于其余两组。

研究结论：
本研究证实，相较于其他用药方案，帕洛诺司琼具有更持久的止吐效果与更低的急救治疗需求，尤其在完全抑制恶心这类不适症状方面表现更优。